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The Milwaukee Journal Sentinel are reporting: Podiatrist's $4,378 bill for hourlong visit stuns patient, other physicians
Quote:
Cliff Blake shows where a nail entered his foot, causing him pain and continued anguish as he fights a doctor's bill.
That was for an hourlong visit with John S. Lanham.
The Milwaukee podiatrist performed an array of procedures, gave Blake a cortisone shot and sent him out the door with an armful of foot and ankle support products.
His foot still aching a week later, Blake went to see a different podiatrist. That doctor did fewer tests but many of the same procedures. The bill came to $315.
Blake isn't the only person to question Lanham's charges.
A few years ago, patients complained about Lanham's high bills to the state podiatric society. That prompted an investigation into the doctor on suspicion of fraudulent billing. The state eventually suspended him for 90 days.
Lanham's suspension ended in April, one month before Blake's visit.
Now that he is back in business, Lanham continues to charge far more than other podiatrists, the P.I. Team found after checking with other local doctors. In one case, Lanham charged $1,700 for medicine that costs $15. Other podiatrists have questioned his charges, too, and were just as shocked as Blake by Lanham's bill.
"This is so far out of the norm, if I wasn't looking at it, I wouldn't believe it," said Steve Kaufman, the podiatrist who treated Blake a week after Lanham.
Lanham referred questions to his attorney, Joseph Fasi, who said his client has done nothing wrong.
The podiatrist has "very high" charges, the attorney said, but there are no rules or laws governing doctors' fees.
"A person can charge whatever they want to charge," Fasi said.
The amount that matters, he said, is what insurance companies pay a doctor for certain procedures.
That's only the case, however, if a doctor is in an insurance company's network.
Insurance companies negotiate discounts with doctors in their networks and pay a set amount. Patients such as Blake who visit doctors out-of-network don't get those discounts. They are responsible for paying the portion of the bill not covered by insurance.
Uninsured patients are responsible for the entire tab.
Since returning to practice, Lanham has taken at least nine former patients to small claims court to collect fees. He has won some cases; others are pending.
Not in insurance plan
Blake found Lanham by flipping through the phone book. He knew the doctor wasn't in his insurance company's network but didn't think a visit to the podiatrist would cost too much. A meat cutter at Pick 'n Save who also delivers papers as an independent contractor for the Journal Sentinel, Blake has been to doctors many times for puncture wounds - just a hazard of his meat-cutting job. He figured he'd have to pay only $300 or $400 for a visit to the foot doctor.
That is generally what a visit would cost.
Doctors have "usual and customary fees" that they charge for certain procedures, said Steven Frydman, a podiatrist and director of the Wisconsin Society of Podiatric Medicine. Doctors working in and out of network stay within a fairly close range of those fees.
"You can't just pick a number out of the air and charge it," Frydman said. "There has to be some rationale."
For Blake's bill, Lanham charged $850 for cortisone and $850 for the medicine used to numb his foot.
The cost of those drugs?
At most, $15, local podiatrists said. That's also the amount they'd charge.
Lanham also charged $85 for two sterile syringes with needles.
Those products cost about 10 cents, podiatrists said. Most doctors don't bill for them or charge $1.
The P.I. Team asked five local podiatrists to review Blake's bills and medical records. The doctors found additional problems with Lanham's billing.
He billed $265 for a "new patient fee." That's at least twice what most podiatrists bill, Frydman said.
Lanham charged separately for supplies, including the syringe and medicine, as well as the injection, instead of billing one price for the shot.
The podiatrist's billing procedures are not new to the Wisconsin Society of Podiatric Medicine, a trade group that developed a code of ethics for its members. That's the group that investigated Lanham a few years ago after complaints rolled in.
Lanham quit the society during the investigation, said Frydman. The investigation was then turned over to the state.
"He has been cautioned by people in my profession to stop overcharging," said Steven Waldman, a podiatrist in New Berlin. "He has had a number of opportunities to change what he's doing, and he just hasn't."
Lanham's attorney said he is not aware that any other podiatrists contacted the doctor about billing.
Most of the complaints to the society came from patients whom Lanham pursued for the portion of the bill not paid by insurance companies, Frydman said.
Shelly Pohlman was one of those patients.
She said Lanham demanded payment after her insurance company paid only $2,700 of a $7,000 bill. Pohlman visited Lanham two years ago after pulling a ligament in her right foot.
Lanham took X-rays and did an ultrasound. He also gave her a cortisone shot, a foot brace - and, a few weeks later, a $7,000 bill.
The bill included $175 for two syringes and needles, $999 for cortisone and $1,099 for the medicine to numb her foot. The podiatrist also charged a $499 new patient fee - nearly twice what he charged Blake.
Pohlman said she negotiated with Lanham's attorney until he accepted $480.
Fasi said Lanham's high costs are no different than a law firm's charging $700 an hour and another's charging $300 an hour for the same work. Or no different than Starbucks charging $3 for a cup of coffee.
One difference is that Starbucks' prices are posted on the board in every store, Frydman said.
Jack Meler, president of HealthCare Direct, said Blake's problems with Lanham's bills show why some people are pushing for more transparency in medical costs.
"If this guy had been told it was going to cost $4,000, he would have limped out of there," said Meler, who runs a health plan that supports price transparency.
Suspended by state
Lanham was suspended 10 months ago after the state said he created false bills and submitted false claims to insurance companies. In its investigation, the state found that the podiatrist billed for procedures he did not perform on patients, according to a final decision and order filed by the state.
In settling with the state, Lanham denied that he knowingly submitted false claims for payment. He did acknowledge that he had "reckless coding errors in his billings," according to the stipulation.
Lanham was required to pay the state $26,739 for the costs of his case. Fasi said Lanham agreed to the stipulation instead of spending time and money fighting the allegations.
The state has received 33 complaints against Lanham since 2001, according to the Department of Regulation and Licensing. The agency considered 13 of those in its disciplinary action.
Lanham has never been accused of harming a patient or giving substandard care, his attorney said. The state's decision to settle with Lanham - and consider just 13 complaints, not 33 - proves that the case was weak, Fasi said.
"If they were right, they wouldn't have settled for a three-month suspension," he said. "They would have gone for his license."
Lanham is the only podiatrist who has been disciplined by the state in the past five years, according to the regulatory agency. No podiatrist has had his or her license permanently revoked in the past decade. One voluntarily surrendered his license.
Blake said he is still angry about Lanham's bill and won't pay it, especially as the amount keeps fluctuating.
On Wednesday, Blake received an updated bill from the podiatrist requesting $956, his share of the total bill. Lanham had removed five charges and lowered the bill to $3,458. Fasi said the bill might have been lowered because of what Blake's insurance company agreed to pay.
UnitedHealthcare, Blake's insurance company, has paid part of the bill using $970 of Blake's health reimbursement account. Blake said he'll try to recoup that from the podiatrist.
Blake said he does not know if the insurance company will pay any more of the remaining bill.
"I think he's back to his old ways," Blake said. "He's just taking insurance companies and people for a ride."
Yesterday's story about Dr. John S. Lanham generated a lot of response from other people who have come into contact with the local podiatrist who the P.I. Team found charges much more than other local docs. Former patients wrote to tell their own tales, as did one of Lanham's former employees and a local insurance agent.
Some of the patients complained that Lanham turned them over to collections agents and tried to ruin their credit after they refused to pay his high bills.
Heidi Cassel said she felt like she was reading about herself as she read about Cliff Blake, one of the people featured in our story. Lanham billed him $1,700 for stuff that costs $15 or less, our story said.
Cassel said she received a $5,000 bill after visiting Lanham and receiving a cortizone shot. He wanted to take off her toenails, but she said she wouldn't let him. When her bill came, she said she told Lanham's lawyer, "I will die before I ever pay this bill."
An 82-year-old woman said Lanham billed her $525 after she stopped in to have him cut her toenails and file down a corn on her foot.
We've placed a call to Lanham's lawyer for comment. We'll let you know what he says as soon as we hear back.
Several of the people who wrote said they were frustrated that the state had not stopped Lanham from practicing the way he does. As was noted in the story, no one can mandate how much a doctor can charge.
Other people had not reported their complaint to the state's Department of Regulation and Licensing. That agency is a "complaint-driven" agency, meaning that it can only act if it receives complaints.
We received a lot of response from people who read this story in November about the local podiatrist who we found bills his patients much more than the average doc. In one case, he billed $1,700 for stuff that costs $15 or less.
Here's an update on what's happened since ... but you'll find it is actually more a story of what has not happened.
In addition to his 3-month suspension last year, Dr. John S. Lanham was required to have an outside billing firm check up on his billing practices and send a report to the state Department of Regulation and Licensing. That agency is the one that suspended Lanham 10 months ago after investigators said he created false bills and submitted false claims to insurance companies.
The monitoring firm was supposed to make sure Lanham was back in the swing of things ... you know, charging patients and insurance companies the appropriate amount.
Public Investigator has asked the state numerous times for a copy of the monitoring report that was finally turned in (a few weeks late, in fact.) Now we find out that there are two reports, but we are not allowed to review them until the podiatry council within the regulatory agency gets the chance to check them out. But that group is not meeting until January.
Michael Berndt, with the state Regulation and Licensing Department, said that his office could still act on what it found in the monitoring report before the podiatry council's review. But the agency is tight-lipped about ongoing investigations and Berndt did not say whether anyone has reviewed the report or was following up with Dr. Lanham.
In the meantime, the podiatrist is still practicing, to the best of our knowledge. His attorney, Joseph Fasi, declined to provide the monitoring report to us and did not want to talk about the case.
Re: Podiatrist's $4,378 bill for hourlong visit stuns patient, other physicians
"He billed $265 for a 'new patient fee.' That's at least twice what most podiatrists bill, Frydman said."
I am assuming this fee is a new patient visit (E&M). I am sure prices vary from one area to another but I do not think $265 is twice what most podiatrists would charge for an initial visit in New York.
There are podiatrists in New York that charge 2-3 times what other podiatrists charge in the same borough. If the practice generates a patient population that is willing to pay those charges, I do not see anything imoral or illegal about it except for the following.
I'm not sure about Wisconsin, but in New York you are obliged to charge everyone the same thing regardless of insurance company or if it is self pay (unless you are waiving part of the bill because the patient can not afford it). The doctor above does seem to be varying his bills with each patient. I think this is more of an issue.
Re: Podiatrist's $4,378 bill for hourlong visit stuns patient, other physicians
Here is the latest on this story:
JSOnline are reporting: High-priced doctor not measuring up to state order, still collecting from patients
Quote:
A local podiatrist appears to be out of compliance with a state order concerning his billing practices.
In the meantime, he’s still trying to collect unusually high bills from patients in the Milwaukee area. His lawyer is settling with some of those patients, recently dropping a small portion of one bill from $1,100 to about $125.
We wrote about Dr. John S. Lanham in November after discovering that he bills his patients much more than the average doctor. In one case he billed $1,700 for stuff that costs $15 or less.
Last week, a state podiatry board made "specific recommendations” for Lanham to "gain compliance with the Board order." A spokesman for the state wouldn’t be anymore specific than that but this review of Lanham was different than last time – In February the board didn’t find anything wrong with the way he bills.
Lanham is required to have an outside monitoring firm check up on his billing practices for two years. About a year and a half ago, state investigators said Lanham created false bills and submitted false claims to insurance companies.
Lanham did not return two calls for this story. His attorney, Joseph Fasi, declined to comment.
A former patient of Lanham, however, contacted Public Investigator today with an update on her bill. Kari Greenlees had been charged $5,100 after visiting Dr. Lanham for “minor heel pain,” she said. Her insurance company paid $2,700 and Lanham wanted her to pay the rest. She refused and the doctor made some adjustments, eventually asking her to pay $1,100. Greenlees said she refused to pay that much and sent Lanham a certified letter saying so. Last month Lanham’s attorney, Fasi, called her and they negotiated down the price from $1,100 to $125.
Podiatrist's $4,378 bill for hourlong visit stuns patient, other physicians
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