u/illegalmonkey

I worked as a medical coder for a big name, three letter healthcare company in the USA(no not THAT one, but you can probably guess) and while it wasn't overly terrible working for them it got much worse once they started auditing more frequently. They started knocking you for not billing a higher, more expensive charge, related to things nobody would ever be able to prove the doctor did. Most times this revolved around documentation cloning from prior dates of service.

For anyone unaware what this means is DR. A. would see a patient one day and document their work, then the next day Dr. B. comes to see the patient but rather than make a new note they just copy over the prior days note and add to it. A lot of times they make only brief statements on "continuing current care" with no specifics about what meds they are using or referring to, giving you very little to go on when coding and billing for that day. The major issue here is you would not be able to use any of the cloned info as 1) it was already billed for on the prior date and 2) the current doctor did not comment on or add to that info.

Multiple MACs(Medicare Administrative Contractors) agree that using cloned documentation is a major no-no: > Cloned documentation does not meet medical necessity requirements for coverage of services rendered due to the lack of specific, individual information. All documentation in the medical record must be specific to the patient and her/his situation at the time of the encounter. Cloning of documentation is considered a misrepresentation of the medical necessity requirement for coverage of services. Identification of this type of documentation will lead to denial of services for lack of medical necessity and recoupment of all overpayments made.

Yet even with that my former employer's auditors, and even managers, told us that a higher level must be coded since “the documentation is present showing a higher level of care”(even though it's proven to be cloned documentation and not assessed by the current doctor). Absolutely, unequivocally, with a doubt fraudulent over-coding. Technically there is no law against this but it is VERY frowned upon in the industry and considered very unethical. The worst part is that with the current government we have there would be zero reason to even tell anyone about this as I already know nothing would come of it. Anyways I just wanted to make people aware, for whatever it's worth.

So my wife is on FB today, mind you she doesn't use it for anything personally so she is almost never on. She sees a post shared by a friend with all this stuff posted for sale. The post said something about their uncle was getting set up in a nursing home so they were selling his stuff to lighten their load. Among the items was a PS5 with a couple games and some accessories for $400. My wife asked me if I wanted it, and me not knowing anything about my wife's friends or former co-workers, I thought of course it must be legit.

Well we tried to send them the money via Paypal with their email addy; didn't work. Then they asked if we could Venmo it to their ph#. My wife went ahead and did this as she already had that friends #, but as soon as she sent it she got a text saying, "Hey btw I have a new # so send it there instead!". This is when she stopped in her tracks. This person then proceeds to send her screenshots of how to send money and what options to select, and we instantly thought SCAM. FYI, this person also kept wanting us to select the "friends and family" option in Paypal. DO NOT DO THIS as that option means your transaction is NOT PROTECTED at all like a typical payment to a legit vendor would be.

Anyways, my wife got on the horn to her friend about what was going on since this friend was asking why we just sent them $400. The friend informs my wife, "Yeah my FB acct got hacked.", and she didn't make that known to anyone apparently!!!!! Thankfully during the fuck up we had sent the money to the actual friend and not the scammer, so we did get the money back.

Long story short, if you get hacked TELL EVERYONE YOU KNOW that you got hacked so your friends and family don't get bamboozled because you didn't think it'd be a big deal!!

Lotta chatter on Nextdoor and FB about new property assessments lately. All seem to be going up by well over 50%. Have seen some comments that it would actually LOWER tax rates but I have no idea how it would, or how it works.

Also some complaints(in Nashua mostly) that assessors weren't actually viewing properties, barely looking(taking just a couple mins), or sleeping in their cars but still submitting assessments. Just curious what others are seeing/hearing.