Author: Philip Yang
September 2015
Ethics is the philosophy dealing with values pertaining to human conduct. Medical ethics regulate the conduct and actions of medical professionals. This regulation may not be bad. Someone said, “What is the value of medical ethics? I don’t care, I just care about how much money I can make in my practice.” Let’s evaluate the value of medical ethics and why it matters.
In February of 2015, at the public hearing of California Acupuncture Board, there was a discussion about one of the acupuncturists from southern California. She was sued for insurance cheating in 2007, and her license was revoked. In 2010, she petitioned to recover her license, and it was refused; and in 2013 and 2014, she continued the same effort, and unfortunately, she failed again and again. She suffered severe damage by losing the trust of her patients, mentally she had to suffer from all the related frustrations in her life and work, financially she exhausted all of her savings, and her children’s schooling was severely affected due to the financial situation. Many very sympathetic, but nobody could help her. She was sued because she intentionally over-claimed MediCal. The maximum payment was $16 per visit, but she made multiple claims to maximize the payment within each office visit. During four years, she claimed over $100,000, and the patient didn’t need to pay a penny. When she was audited by the government, her cheating was exposed and she received a large fine.
The acupuncturist paid back all of the income she claimed from MediCal, and she received another fine, her license was revoked, and for over ten years, she could work professionally but receive no income. We can imagine how much she suffered in the ten years mentally, how much she lost financially, how much she felt regret for what she did. However, nothing could help her improve her situation. How much does Medical Ethics matter? Literally, it’s worth nothing, but if you throw it away in your professional practice, it matters a lot. Many medical professionals have gone bankrupt in a similar way, including acupuncturists and chiropractors.
Let’s look at another report in September 2015. In Vancouver, an acupuncturist’s license was revoked, and she was fined $450,000 Canadian dollars because she cheated her claims within the state medical system MSP.
According to the audit report by the Health Department of British Columbia, the acupuncturist, Susan, made claims to MSP for up to $600,000 Canadian dollars from April 2008 to December 2010. 99.7% of the claims were illegal. Since 2000, she had been managing a business of water therapy, which she combined with her acupuncture services. The service record indicated that both of these services and income were mixed together, which meant she had made medical claims for acupuncture through her water therapy service.
The MSP benefits in British Columbia (B.C.) include 10 visits per year of acupuncture services at $23 per visit. The Health Department noticed the wrong claims by finding the incorrect number of service records, auditors found that she had provided acupuncture services to multiple patients within an hour, and the youngest patient was four months old. In 2012, the infant had accepted 10 visits of acupuncture services. So, The College of Traditional Chinese Medicine Practitioners and Acupuncturists of B.C. started an investigation into Susan’s services. In September 2014, the State government agency revoked her acupuncture license for 12 months, and if she wanted to restart her professional practice, she would have to accept random investigations at any time.
It is reported Susan accepted the amount of her fake medical claims through MSP between 2011 to 2012. The claimed amount was up to $453,000, and she agreed to pay back $450,000 Canadian dollar to the government. In California, many acupuncturists are practicing this kind of business, and for a period of time, they make “fairly good income.” They ignore the laws and regulations, and encounter problems eventually. Once the problem is exposed in Canada, they add up all of the income, legal and illegal, to create a fine. It doesn’t matter how much income you have, you can lose everything.
Recently, in the South Bay, another acupuncturist was sued. She claimed acupuncture services for her massage work, and after an investigation, the California Acupuncture Board revoked her license immediately, and the legal actions that followed are now in process. Medical ethics is not just a measure of one’s professional conduct, it is also a measure of one’s integrity, and it reflects the laws and regulations, regulates and limits one’s behavior, while also protecting your best interests. Once someone breaks this ‘regulation’ or ‘limit,’ he or she has to pay for it, and this payment is definitely not equivalent to what he or she gains. If you understand there is a valley in front of you, everybody will fear it, and the best solution is to stay away from it. Similarly, when driving on the road, speed is not the most important thing, safety is the highest priority. Medical ethics is your “Shield of Safety.”
Some common risky practices can include:
- Practicing massage and claiming for acupuncture services
- Practicing aesthetics and claiming for acupuncture services
- After a one time office visit, claiming the insurance benefit for the whole year, and gradually saving it for future use
- Trade between the practitioners and the patients, such as providing a one time service or service a few times, and claiming the benefit for the whole year, splitting the money claimed, and once there is an unfair distribution, it can lead to trouble or become a legal issue
- After limited services, claiming the full benefit, and the practitioner buying gifts for the patients as rewards, with the patient ordering what they want
- Substituting the use of one’s insurance benefit, such as a mother using the benefit from her daughter’s insurance
All of these unprofessional behaviors are very dangerous, as they will not only destroy oneself, but it can damage the reputation of the entire profession, eventually leading to the profession suffering legally. Every practitioner must improve their professional knowledge and techniques through continuing education, and the American Association of Chinese Medicine and Acupuncture (AACMA) provides many educational opportunities to hear from well-selected professors and specialists who share their knowledge and experience with topics, including medical ethics.
Here is a final example: a dentist was currently fined by the IRS, because his wife deposited the money to his personal account in the amount of $450,000. The dentist admitted his guilt and returned the entire $450, 000 to the IRS. This example is a reminder to practitioners and business owners that one cannot avoid or reduce one’s tax payments, even a penny. All the income through credit cards, checks, and cash must all be reported to the IRS, otherwise you can get into trouble when audited by the IRS.
Medical ethics is a regulation, and it is better to regulate yourself, as once you are regulated by its actions, it can be too late.