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Question DetailsAsked on 6/23/2014

Can a physician withhold info from you, unless you specifically ask, to direct you to one source for a purchase.

Dr. automatically signed me up to get procedure prep supplies from a specific mail order company and provided me information that discussed this one company only. The company is a Business Associate of my healthcare provider. When I specifically asked if I had to use the company they did admit that I did not have to order from them. I found the same items at my local pharmacy for 50% less versus ordering them through the mail order company. Had I not known to ask I would have overpaid and my provider will not tell me why they withhold the self purchase option unless specifically asked.

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3 Answers

0
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If you mean the prep supply company is a business associate of the doctor as in he has a financial interest in to, and he did not disclose this to you, that is a blatant conflict of interest and contrary to the code of ethics, and as I understand it also fraud under federal health laws - and would probably also result in loss of his insurance associations with major insurance companies.


If you want to follow up on this, you could talk to the local district attorney consumer fraud contact, and/or file a complaint with the state medical board. He could get a severe reprimand or potentially a license suspension for this practice.


If you mean the supply company is an affiliate or subsidiary of the insurance company, then probably equally illegal tonot disclose that relationship, except maybe in case where they would be paying the entire bill without any deductible or co-pay being charged to you for the supplies, in which case it would make no difference to you probably.

State insurance board or commissioners or whatever it is called in your stte would be the ones to ask about above situation with insurance company.

Answered 5 years ago by LCD

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ADDED INFORMATION TO QUESTION- My physician is part of a group. The mail order company has Business Association with the group. I felt this was at a minimum a violation of HIPAA regulations because they are marketing the mail order company specifically and HIPAA states that in order to release my protected health information for Marketing purposes the provider must have my permission. The requirement is very specific about this especially if the provider receives any renumeration in return. I contacted the provider's HIPAA representative and they say the provider receives nothing in return for using the mail order company. I agree that they do not receive cash, but they do receive a service. The mail order company takes care of all patient notifications, supplying prep instructions to patients, answering any questions patients may have about the prep. This service does have cash value to my provider since they do not have to pay postage for reminders, print instructions, and have a person available for this function. It is clear that they must provide enough business to the mail order company for them to cover the costs of these services and make a profit, which is why the prep items are more expensive. This puts my provider in a conflict of interest because if they don't provide sufficient business to the mail order company they will most likely be dropped and lose these services and will have to provide them on their own. If they truly do not receive anything in return for using this company then why do they withhold the self purchase information unless specifically asked. Why not give all the options up front, isn't it a patients right to know all the information up front? Most patients do not know to ask. The Doctor is an authority figure so patients will blindly follow their instructions and I'm sure some of these folks like myself could use the money saved for better things. Insurance does not cover the cost of these items in any case.

Answered 5 years ago by usrmbhr1

0
Votes

My take on this, after reviewing the HIPPA rules :


Sure looks like a violation to me IF there is any financial link between the companies. If the supplier is just a company the doctor refers patients to, even if more expensive, as long as he or family member is not an employee or owner or officer of the company then probably not illegal or fraud or unethical, any more than if they send out a sample for testing to a lab company they routinely use even though there might be a cheaper one that could do the test. So when you say "Business Associate" if you mean a company thery do business with probably is not fraud or business collusion - if he has any ownership interest or receives any sort of referral fee or such, then probably fraud and probably an illegal kickback.


As for the HIPPA factor - if he provides them with customer data without customer approval then probably a violation, but if the supplies are ordered through them on your behalf and you do not object, then he is acting on your behalf and the supplies company then becomes a medical provider to you also, so he can transfer such data as is needed to process the order and payment. If THEY then sold your info to other parties for marketing, THAT would be a violation.


So - appears to me it all hinges on whether this is just a company they use as a provider the same as a lab or referral imaging center or therapist or such; or if there is a true financial return to the doctor from your service. The supply company handling the paperwork and processing and such would not in itself be a benefit to the doctor - that is just the company handling the paperwork that goes along with the order, same as a pharmacy handling a controlled drug prescription and doing the associated record-keeping to comply with federal requirements.


As for what to do about it - you could contact the supply company requesting your info be deleted from their records (assuming you did not end up using them). You could let doctor's office know you are upset about being referred to a source that costs 100% more than a pharmacy. You could contact your state medical board with the info requesting an investigation, though the doctor would know you filed the complaint. If you KNOW and have evidence he gets a benefit from this arrangement, you could talk to the person who handles consumer fraud at your state District Attorney's criminal prosecution office.

Answered 5 years ago by LCD




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