The Lien Doctors

These are the articles that sicken me. I know it is a small set of our profession but it still is sad. The article in the WSJ talks about how:

Lawyers can refer interested plaintiffs to specific lien doctors or to online directories such as Doctors on Liens, Power Liens or Global Lien Doctors. The networks include orthopedists, plastic surgeons, dentists, chiropractors and other specialists.

The interested plaintiffs above are ones involved in personal injury lawsuits. Do you see where this is heade?

The fine print of typical contracts bar patients from submitting claims to insurance and hold them responsible for the full bill no matter the outcome of their lawsuit.

The article says if the client loses the lawsuit the bill may be negotiation down. Still, few people know how much money does NOT go the victim/client:

  • Personal-injury lawyers typically receive contingency fees of between one-third and 40% of any settlement or verdict, meaning they benefit if their clients are awarded higher damages.
  • Lien bills can be as much as seven to 25 times higher than what insurance will pay.

Sorry, but this embarrasses. Maybe the lawyers out there don’t care but we doctors should Seven to 25 times higher than what insures pay? That’s legal? And how do these docs sleep at night?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “The Lien Doctors

  1. Aaron M. Levine
    January 30, 2020 at 10:51 am physicians should know about “Letters of Protection”

    NOVEMBER 7, 2019
    by Brian Dittmar and David White

    You are a health care professional in Texas who has entered into a routine managed care contract with a health insurance company. You have agreed to discount your charges for medical services in exchange for being “in network.”
    You are treating a patient for injuries allegedly caused by the medical negligence of another physician. The patient is represented by an attorney who is pursuing a claim for damages against the other physician.
    The patient’s attorney contacts you with an interesting proposition. Would you like to be paid more for your services than what you would receive from the patient’s health insurance carrier? In fact, the attorney has no problem if you want to bill an amount significantly higher than insurance contract rates. All you have to do is agree to not send the bill to the patient’s health insurance. The attorney will even give you a “Letter of Protection” that promises you will be paid the full amount of your bill when the patient’s liability claim is resolved.
    The laws in Texas governing health care liability actions state that claimants are only allowed to recover damages for medical bills that are actually “paid or incurred.” Accordingly, a claimant “without” health insurance has more costly medical “bills” to claim than a claimant who is insured. If your bill is not submitted to the patient’s health insurance, the attorney will produce your bill and the letter of protection as proof of “incurred” medical expenses that should be awarded as compensation.
    Then, when the liability claim is resolved, you are surprised when the attorney offers to pay you an amount less than what you billed. The attorney might tell you that case expenses were higher than anticipated, the settlement was not as much as anticipated, etc. You decide that even though your patient and attorney have collected compensation based on the amount of your original bill, a compromise in the amount you will accept is better than going through the time and effort of collection attempts. In the health care liability insurance industry, the term for the difference between what is awarded and what is ultimately paid to you is “phantom damages.”
    A general principle of Texas law requires claimants to mitigate their damages. However, it is not clear whether a claimant’s decision to not use otherwise available health insurance in these circumstances represents a failure to mitigate damages.
    This past legislative session, two bills were filed that attempted to add the following clarifying language to the statute. “The trier of fact shall consider a claimant ’s failure to seek reimbursement for medical or health care expenses that are obligated to be paid on the claimant ’s behalf a failure to mitigate the claimant’s damages.” Unfortunately, neither bill advanced out of legislative committee.
    Those physicians who agree to accept a Letter of Protection in lieu of submitting charges to otherwise collectible health insurance are put in an interesting position. Yes, they might someday be paid more for their services than they would otherwise collect under their contract. However, they would also be participating in a scheme intended to subvert the “paid and incurred” provisions of Texas law. Please consider that by helping to facilitate awards of “phantom damages,” physicians may be working against the long-term interests of all health care professionals and their patients.

  2. Aaron M. Levine
    January 29, 2020 at 5:43 pm

    This is what was the contingency fee. Years ago it was considered unethical. I understand some specialty societies still are against it. I have done reviews and IMEs. Most are for the defense. I have been surprised about the testing and diagnoses made to justify procedures. This is not just different opinions, but outward distortion.

  3. R Stuart
    January 29, 2020 at 1:51 pm

    The practice next door to mine gets paid (counting facility fee) 600% of what I get for a 99213 simply because they’re owned by the top-ten academic medical center three counties away. Not any different from what you describe.

    We need to get over this childish idea that physicians hold themselves to any kind of superior ethical code.

    Outside of DPC docs, we’re all whores turning tricks – some cheap, some expensive.

    • Pat
      January 30, 2020 at 9:04 am

      Amen, and I’ve said that for years. Health care – all of it – is a fundamentally dishonest industry, and that includes doctors. DPC physicians are the only exception.

  4. Benjamin Van Raalte
    January 29, 2020 at 11:39 am

    You expect ethics? From people who are being paid to say what the trial attorneys want said? Now they want the same payoff as the attorneys and justify it that they might not get paid on losing cases. Remember very few countries allow contingency fees or a loser does not pay costs legal system classifying it as immoral,championing as unjust cause.


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