Examinations Under Oath and Insurance Company Silliness

I recently represented a Licensed Massage Therapist at an Examination Under Oath (or EUO, for what should be obvious reasons).  Present at the unusually long conference table were the typical insurance carrier archetypes I know so well: the pleasant questioning attorney for the insurance company, the stone-faced and silent SIU representative, the court reporter with her mysterious mini-typewriter and stacks of exhibit tabs and four freshly-minted insurance lawyers who were being trained in “Insurance Fraud 101.”

As you probably know, most of the questions asked during a No-Fault EUO focus on rental or ownership of offices and facilities, billing and treatment of individual patients, and where the money ultimately ends up. 

The pleasant questioning attorney covered all of these topics at my client’s EUO.  Unfortunately for the insurance company, the mythical smoking gun they were looking for remained nonexistent. This particular client does his very own billing right down to filling out the certificates of mailing by hand. Oh, and if you wondering, I have my client’s express permission to provide this information.

But this post isn’t about my particular client, who ended up being paid his bills despite the significant delay caused by this very silly EUO. 

It’s about one of the very silly questions asked that day.

During the questioning of my client’s billing on a particular patient, the stone-faced and silent SIU representative scribbled something on a pad, pushed it over to the pleasant questioning attorney, and pointed a few times at it.  (This means that the SIU rep wanted a particular question asked because it is really, really important and could be a !Red Flag! fraud indicator. I’m not quite sure how the pleasant questioning attorney and the baby lawyers kept a straight face but….

Well, you be the judge. Here is the question:

“These are the bills. I will refer to the date of service 2/27. For this particular bill is there a reason why the lines are not in here?”

PQA referred to a copy of my client’s HCFA-1500 form (click the attached image above to see the full form)… on which the red lines (the copy of which were grey) were somehow mysteriously lighter than the information my client typed onto the form.  Wow, Stone-Faced and Silent SIU rep found the golden ring of fraud!

Sadly, my eyeroll was not audible, so the court reporter could not include it on the record.  I responded with emphasis “IF HE KNOWS!” Unfortunately, the steno was also unable to take down the tone of my voice. She could not use ALL CAPS, like I did above, so that portion of the transcript is not worth printing here.

Because EUOs are creatures of policy and statutory construction, that was really all I could say.  My client actually had to answer the absurd question.  And, unless he provided another copy of the same bill for the carrier to compare, his bill could be delayed based upon lack of proper verification of claim.

What on earth the SIU representative was thinking, I have no idea. But, if insurance companies really think they have to dig to the bottom of the barrel like that to uncover what they are convinced is the fraudulent behavior of health care providers who have the audacity to treat victims of automobile accidents, then I believe policy and share-holders certainly have the right to know about it.

If you are interested in more insurance company silliness, pop on over to Bad IME, a site which exposes the actual shenanigans of doctors who do work for insurance companies.