Damned if you do and Damned if you Don't: The Double-Edged Sword of Caring for Poor Patients in Medicine

Providers who take care of the poorer patients in our health care delivery system are usually black  physicians. Most of their patients are on public assistance, either Medicaid or Medicare. It is well documented by health care researchers that blacks in America compared to whites have a higher incidence of heart disease, diabetes, hypertension, renal failure, complications from diabetes, "excess deaths", and lesser on longevity. Knowing these documented facts, the billing patterns for black doctors will always be higher than doctors who practice in more affluent communities. Unfortunately, when Medicaid and Medicare contractors and other health care regulators review the billing patterns of physicians practicing in these poor communities, they unfairly compare you to "peers" who are white and do not care for the same type of patients. Black doctors treatment of the sicker patients are perceived as "excessive" or "over utilization" of medical services. This is conceived as fraudulent and most often will be investigated. Any black doctor in a poorer neighborhood who crosses Medicare's threshold of $500,000 per year has a nearly 100% chance of a being investigated for fraud by the FBI, OIG or the Medicare contractor. Once one of the health care regulators start an investigation, an onslaught of other federal and state agencies are very close behind. The black doctor has to get legal representation and begin to fight on multiple fronts. Physicians who have never had no criminal record, professional career is now in jeopardy for fulfilling his promise and oath that he took at graduation. This happened to me in 1997, forcing me to close my practice in 2001 and it continues to happen to black doctors all across America in 2013. Feel free to share your story with me at the link below:


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Problems Faced By Minority Physicians

My story

I am Dr. Dralves G. Edwards from Dallas, TX and  I am board certified in family medicine. I practiced in the southern sector of Dallas from 1983 to 2001 when I was forced to close my doors. My patient base was primarily Medicare patients. I provided free transportation, I made house calls on my patients and I worked closely with home health care agencies. I treated patients in over 55 zip codes, mostly poor and elderly. I earned over $500,000 three years in a row(1995-1997). On August 22, 1997, Blue Cross Blue Shield of Texas, the Medicare contractor, placed me on a 100% prepayment review. They required me to submit claims with documentation before they would pay the claims. I had no prior adverse dealing with Medicare prior to this transaction. The reason they use to place me on the review was they compared my billing pattern with my "peers". My peers did not have similar practice. For 3 consecutive years, they denied 96% of my claims as non covered services and not a medical necessity. Medical conditions like breast cancer, congestive heart failure, decubitus ulcers, hypertension, diabetes were denied as non covered. However, when I sent the same patients to different doctors, the contractor paid them with no problem. I met with HHS and Blue Cross to see why they were denying my claims. At that meeting, they said the medical services were medically necessary and told me to sign all my progress notes, resubmit the claims and they would be paid. I did as I was told. They were rejected for payment for the same reason. I was forced to exhaust all of my administrative remedies to get my claims paid. Most of my claims were found to be meritorious and were paid in this 5 year administrative process. I filed a civil suit in state court against the contractor for fraud, gross negligence and criminal activity. Three jury trial dates were set but were canceled after Blue Cross legal counsel became the judge's largest campaign contributors. One judge was given $5,000 on the day of the trial and the judge canceled the trial. I appealed my case, a pro se writ of certiorari, to the US Supreme Court in  September 2009. It was denied. I am now in my 17th year trying to get a trial by jury. It seems that doctors trade in their constitutional and civil rights when they get their medical degree. We are working on getting this case before a court in the very near future.


I have created this blog as a way to expose how Doctors are being treated everywhere. Please see the article and the link to my youtube channel below.

http://enewschannels.com/2009/09/25/enc8871_161914.php/

http://www.youtube.com/sevlard