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Can a first year med student legally treat patients without direct Dr. oversight?

64 posts in this topic

Posted · Report post

During my recent tachycardia issues I went to an Urgent Care to get an ECG. I'd asked specifically if I'd be seeing a physician, as I wanted a physician level assessment, as was told that I would.

While waiting a young man came in an introduced himself as a medical student and asked if it was ok if he interviewed me while I waited for the doc. I said 'sure.' It was obvious that he had no real idea how to do such an interview, he kept checking a sheet of paper for further questions, but ended up asking only a half dozen or so. No touching of any kind was done. They did an ECG, and he then came back in an explained that he was confident that I was having anxiety issues and that I should try and relax, but not to worry about it. When he was leaving I said, "How far along are you in school?" He said, "Well, actually I'm just starting my second year of school." I'm not sure if that is medical school, or school in general.

He left, and then a girl came in and started to take my information, gave me a printout of my diagnosis, and then it occurred to me I wasn't in fact going to see the doc at all. I thought, "Well, screw it, I'll pay my hundred bucks and go to a different doctor." I'd asked about price before my appt and was told that they couldn't tell me specifically, and then after, that it couldn't be figured right then because of the ECG, that I would be billed. But I recently received my bill for $954.00.

I've never known an urgent care to charge so much, but $400 of that is a "new patient physician consult."

The next doctor I found did an actual assessment and ecg and discovered a dangerous medicine interaction that was most likely causing my tachycardia issues and could have been really dangerous if left undiscovered...

I'm guessing that this medical student doesn't have any legal level of certification, so I'm wondering, as I wait for my next phone call to fight my bill, if it's even legal for him to treat patients without direct oversight? And are there morals and ethics surrounding the doctor billing for his physician level services yet sending his medical student in instead, and only?

And lastly, has anyone EVER been billed a grand for a quick care/urgent care visit???
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Posted · Report post

No, yes, and no.

A medical student does not have an MD degree, and therefore no license. They cannot bill. A first year RESIDENT (and that may be why they identified themselves as a student) can see and treat patients, but not independent of oversight by an attending (typically has to review each case directly, as well as any diagnostic adjuncts. Many don't necessarily see the patient themselves.). They also have no license until they have completed their first year of residency, Step 3 of the USMLE, and complete the state's licensing process.

Billing for this without being seen by a physician is fraud. Without a physical examination, you can't bill at that level either unless you are a psychologist. A level 5 coding requires examination of a certain number of body systems, history points to include medical, family, and social history, and a review of several body systems (ROS). Call the billing company and explain this, and they should write it off. If they push back, mention the fact that an actual doctor found it was due to a dangerous condition, and that should also make them lean toward writing it off.

What probably happened is that the doc probably got busy, staffed the patient with the student, then didn't see you though the medical student thought he did.

'zilla
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Posted (edited) · Report post

Sorry bud, I can't speak to the legal issues, but I would be irked to be billed for a physician consult when I was never exposed to a physician. I'm sure that your bill will likely go away though when the Urgent Care Clinic is informed of the results from your second opinion.

Edit: 'Zilla's response came in as I was typing up mine. He seems to have good facts. :) Edited by Arctickat
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Posted · Report post

I already responded via facebook.
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Posted · Report post

Just hope you are ok man. Hopefully they trash the bill.
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Posted · Report post

First off Glad you discovered what was causing the problem
Second. I'g tell the urgent care clinic you were forwarding their invoice to the state attorney generals office for fraud investigation & maybe even the feds for violation of medical practice.
As a licensed Paramedic , you more than likely have more education and training than a first yr med student.
We gave you a better exam over the internet than they did for a grand.
My invoice in the amount of $300.00 will follow.
:mobile:
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Posted · Report post

Next time you need a 12 lead done , stop by the local ambulance service and I'm sure they would be glad to provide a professional courtesy freebie.
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Posted (edited) · Report post

I would go get a copy of your medical records before they have a chance to alter them and add "Physician Notes" like he really saw you; then I would follow up with whatever regulatory body your state has to oversee Doctor's offices and hospitals. If such a thing exists ?As far as the bill, there are ambulance services that charge just as much to transport someone less than 10 miles. That's the american health care system, jack the price up 4 times what it should cost so that the people with insurance pay for the ones without insurance. Edited by mikeymedic1984
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Posted · Report post

I agree with what Zilla said. Medical students cannot legally bill, nor write the chart for billing purposes. In the 2 states I have practiced in, even with residents, and attending physician must see every patient (I'm pretty sure this is either and RRC requirement or possibly a CMS requirement). Is there an insurance company involved? If so, let them know. They love to not pay for things and this may trigger some form of investigation. Evey state also has a medical board that oversees the licensing of MD/DOs. You could contact them also.
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Posted · Report post

Thanks...not ignoring the thread but traveling back to work...

No insurance...it's under review...but I'm going to make it ugly if they don't play ball ...Thanks for all of your help...I'll update with a resolution...
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Posted · Report post

Hey Dwayne, what state did this happen in and is the doc an MD or DO? Also, do you know what medical school this med student was from? I'm sure the school would love to know that it's students are not being properly supervised.
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Posted · Report post

I'll have Babs check the Bill for the doc's official title...I'm assuming the kid is from a local school...
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Posted · Report post

Did this happen in Colorado?
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Posted · Report post

Oops...sorry...Yeah, Colorado Springs....

(Apologies to all for my crappier than usual posts. My computer died so I'm posting on my Kindle...it's a trial..)
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If you are really interested in pursuing this, you can start here:

http://www.colorado.gov/cs/Satellite?c=Page&childpagename=DORA-Reg%2FDORALayout&cid=1251632503133&p=1251632503133&pagename=CBONWrapper
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Posted · Report post

I'm actually pretty interested to see how this develops. Seems like you have yourself a situation in which they're at fault in so many ways. If the billing company doesn't see it that way, I'm sure you could call the doctor up directly, too...If the billers aren't worried about it, he definitely should be...
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[quote name='AnthonyM83' timestamp='1355348251' post='291470']
I'm actually pretty interested to see how this develops. Seems like you have yourself a situation in which they're at fault in so many ways. If the billing company doesn't see it that way, I'm sure you could call the doctor up directly, too...If the billers aren't worried about it, he definitely should be...
[/quote]
Unless the doctor is complicit in the entire thing as well.
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Posted · Report post

As a doctor, he knows better. There is nothing right about what he did.
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But Doc, I'm sure that you know doctors who don't really care and are just in these URgent care centers for the money right? Or were you referring to the student? We might not be talking about the same individual.

I'm saying that the doctor who is running things might not be too concerned about Dwayne's bill. Makes me wonder if this isn't a pattern that is prevalent at this particular clinic?

And yes in a perfect world, the doctor should be worried about it but he just might not give a shit
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According to a message left at home the Dr. is claiming that he saw me and did a full assessment. Babs sent me his bio from the hospital web site, with his pic, and I do remember seeing that doctor sitting in a little computer nook visiting with some nurses or such, but he never spoke to me, and certainly never entered my exam room...

But if all involved are willing to lie about it then I don't really see any way that in not going to take a bath on this...

In fact, the last thing that the medical student said to me was, "and the doctor agrees with my diagnosis.." but like an idiot I'd assumes he was doing some polite bragging before the doc came in..

Babs is doing the research regarding the steps necessary to file a formal ethics complaint, starting with the link kindly provided by the Doc, but if they are all willing to lie, what can be done?

It's so frustrating trying to fight this from another country on a gig so remote that I only have phone or internet foe a few hours per week...but it's gone way past being an issue of money now. I can't really lay down on the ethics..
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Posted · Report post

Sorry you're going through this!! I've had to fight doctors before and insurance companies so let me know if I can do anything!
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Posted · Report post

I'd turn in a complaint with the state attorney generals office. They have a fraud division and what happened to you constitutes fraud and malpractice.
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Posted · Report post

Thanks Kate...

Yeah, I'm pretty pissed off now, so will be following this up to the highest levels that I'm able...

I truly expected, after all was explained, that they would say, "Ooops, sorry, we dropped the ball that day." But I'm a complete believer that mistakes will be made, and should be forgiven if those that make them are honest about them. Now that I know that they will try and cover their behavior with lies I can't really let it rest. Plus, I've kind of been aching for a fight, so this gives me one that I can feel pretty good about...
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Posted · Report post

Keep us updated as it goes on. You should see if someone else can go in there with a recorder of some sort and record the interactions. You could also look into filing a complaint with CMS. The govt loves to take our money, but it hates to have money taken away.
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What is CMS?
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