The Voice of Podiatrists

October 10, 2006 #2,710 Editor-Barry Block, DPM, JD

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OH Podiatrist Accused of Cashing Other Practices’ Checks

What started as a favor when a Westerville podiatrist agreed to pick up other doctors’ mail has ended in theft accusations. Dr. Walter Shonkwiler, a podiatrist, is facing felony theft charges for depositing into his own account $7,220 from 17 checks to another practice. The money should have gone to Corporate Health Solutions, a practice that Dr. Patricia David runs with her husband, Dr. Ryan Herrington.

Shonkwiler, 49, is scheduled for trial Oct. 23 in Franklin County Common Pleas Court. He faces two counts of felony theft plus two unrelated charges of passing $2,500 in bad checks to his medical office landlord. If Shonkwiler is convicted, he could be disciplined by the State Medical Board, said Joan Wehrle from the state agency. The discipline could range from a reprimand to a license suspension.

The case began in February 2004, when David and Herrington temporarily suspended their practice because of the impending birth of their third child. Corporate Health Solutions was next door to Shonkwiler’s Ankle & Foot Institute in a medical building. With payments still coming into the office, Herrington asked Shonkwiler if he could collect the mail. "What I should have done is get a post office box, but being the trusting person I am, I trusted Shonkwiler," Herrington said.

Source: Jim Woods, The Columbus Dispatch, [10/9/06]

AAPPM Website Launches New Free Job Bank

The American Academy of Podiatric Practice Management (AAPPM) has announced that its website, www.aappm.org, now features a new, free job bank available to AAPPM members and others in the podiatry profession. “We view this as a great new member benefit for our members, a new way to build traffic to our web site from prospective members and a unique way to give back to the profession that has given so much to us,” said Bill McCann, DPM, AAPPM president and AAPPM Communications Team chair.

Job and résumé listings posted on the new AAPPM job bank will remain active for 60 days from the date of posting and can be easily renewed for another 60 days or deleted as is appropriate. So, if you have a physician or staff job to fill or are looking for a physician or staff position you can now post your listing free online at www.aappm.org. “We are aggressively promoting our new website job bank service to our members and the profession and expect it to be very successful.” said Dr. McCann.

Physicians Often Fail To Impart Drug Information

A study published in the Archives of Internal Medicine found that physicians "often fail to communicate critical elements of medication use" and do not regularly describe possible adverse effects of the drugs they prescribe. Commenting on the study, Sidney Wolfe, director of Public Citizen's Health Research Group, said that the inadequacy of information patients get about adverse drug reactions was "a serious public health problem." "The most important finding of this study is that only 35% of people are being given information by their doctors about adverse effects," Wolfe said.

Source: Baltimore Sun via Modern Healthcare [10/9/06]

FBI Alleges 18M Medicare Fraud Against Dr. Comfort

An affidavit relating to the search warrant executed by FBI agents on March 23, 2006 at Dr. Comfort Shoes outlines allegations of an $18 million Medicare fraud scheme, first reported to authorities by the company’s former chief operating officer.

David Schlageter spoke to FBI agents on March 19, after striking an immunity deal with the government. He told the agency that Dr. Comfort - which deals in shoes and shoe inserts for people who suffer from diabetes - sold heat-molded shoe inserts that did not meet new Medicare standards for reimbursement, but claimed otherwise, over about 18 months.

Source: Ed Zagorski - GM Today via Ozaukee County News Graphic [10/6/06]

Editor’s note: Dr. Comfort’s response to these allegations appears in the Responses/Comments section of today’s PM News.

Query: Theft By Partner

I’m involved in a successful partnership. Because my partner is more financially adept than me, I have always let him balance the books. Recently, I checked the money he deposits into the practice account and discovered that there’s a discrepancy between the co-pays we record each day and the amount on the deposit slips.

I thought about the possibility that our office manager (or one of our assistants) was taking the money, so I asked her to keep track of how much she gives my partner each day. I made sure that an assistant was around when the money was transferred, and had her announce the amount aloud to my partner. What should I do? Confront my partner? Call the police? Or something else?

Name Withheld

Query: Excision of Keloid Coding

I am having a hard time finding the appropriate procedure code for the excision of a keloid (hypertrophic scar). Can anyone help?

T.J. Miller, Office of Lawrence Gaston, DPM, Lawrence, KS

Response: It's difficult to give definitive coding advice without reviewing the documentation in this case. There are several areas of the "integumentary system" of CPT that could potentially apply to your situation depending on the surgical technique that you used.

Excision - benign lesions (CPT 11400 - CPT 11446)
Repair - complex (CPT 13100 - CPT 13153)
Adjacent tissue transfer or rearrangement (CPT 14000 - CPT 14300).

Heidi Stout, CPC, CCS-P, University Orthopaedic Group, New Brunswick, NJ

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: FBI Alleges 18M Medicare Fraud Against Dr. Comfort
From: Dr. Comfort

Dr. Comfort continues to cooperate with a government investigation to determine if non-custom inserts previously distributed, complied with SADMERC standards as they then existed. Recent reported events reveal that that the former compliance officer of Dr. Comfort, after leaving to start a competitive business in early 2006, sought immunity from the federal government, alleging that inserts he previously certified as compliant may have been non-compliant in sole density.

Since the above events became known, Dr. Comfort has conducted a rigorous internal investigation that has verified that the company continues to produce the highest quality specialized footwear on the market. Dr. Comfort has received SADMERC approval for its new A5512 pre-fabricated inserts. Copies of this approval are available on our website at www.drcomfortdpm.com

RE: 2M Verdict From Corn Removal
From: Joseph S. Borreggine, DPM

I have a plethora of "nail salon victims" who have had fungal infections from a "pedicure" and PM has addressed this issue. But, about a year ago, an elderly women who was a "brittle" diabetic at the time, came into my office and stated she had received a "pedicure" from a nail salon. She had an infected corn on the R 5th MPJ. She stated that the "nail technician", at a local salon, trimmed this callous on the R 5th MPJ and "cut her" in the process. The technician told her to clean it with peroxide, bandage it or soak it. The patient was concerned and came to me on her own.

I did the general diabetic work-up on both of her feet and legs. There was an infection in the area in question with noted cellulitis. She had no palpable pulses in either foot. She was the "typical at-risk" diabetic patient who had all the signs and symptoms of PVD/ASO. Further questioning revealed that she had "1-block claudication" and "rest pain" in both legs. She was immediately referred to a PV specialist who hospitalized her and tried a stent placement. It failed. She was not a bypass candidate and eventually succumbed to a BKA on the R leg.

She lost her leg because a nail salon employee (with no medical training) trimmed a "corn" and cut her "by accident." The result of this injury was "zero liability" for the nail tech.. If it had been a podiatrist, then the result would have been the same as the DPM in PA. Why doesn't the APMA or state licensing boards "step up to the plate" and "put the clamps" on "beauticians, visiting nurses, and the like" who perform nail/callus care on "at-risk" clients. There needs to be a shifting some of the same liability we face as DPM's to these nail technicians who trim calluses and corns on "at-risk" customers" and cause so-called accidents"?

Joseph S. Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

RE: Podiatry Eats its Own Young (Simon Young, DPM, Richard Boone, Esq.)
From: Barry Mullen, DPM, Bryan C. Markinson, DPM

It sounds like Dr. Young may have been victimized by the actions of an unscrupulous colleague(s) at some point during his professional career. If this is true, that's a shame. It's a gross injustice to negatively stereotype an entire profession based upon the actions of a few. Show me one unscrupulous podiatrist and I'll show you 50 professional, quality healthcare providers. Newsflash....all professions have rotten apples! You can either let that fact consume and embitter what was likely once a pleasant and altruistic demeanor, or you can press ahead and display the professional conduct becoming of a quality healthcare provider.

In so doing, by example, you become a leader of good men and women within your profession by showing them that the golden rule still reigns supreme. Can't think of an instance where taking the high road leads to anything but success. Besides, what goes around truly does come around, so have faith that those that have taken advantage of their colleagues will ultimately pay the price.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

I was surprised by Mr. Boone. He is ordinarily a fair and balanced advocate. Although he earns his living as a defense attorney, he has admitted that there are indeed plaintiff's experts who are truthful and defense experts who are not. I won't argue his point about the residency director who testified against his former resident, except to say that there are far more serious examples of podiatry eating its young. But I really wonder, would Mr. Boone assert that at another time and place, a residency director should feel compelled to testify for a defendant just because said defendant was a former resident? Would a plaintiff's attorney make an issue out of the fact that the defense expert is the defendant's former residency director?

I am a residency site director. I treat my former residents with love and respect. I am harsh when I perceive their actions unbecoming or below par, and support them when they perform well. I guarantee every one of my colleagues that if I am reviewing a case in which they are named as a potential defendant, they should be glad that I am the one reviewing it, regardless of which attorney is asking for the review. This includes former residents and students. I will tell the truth when I am qualified on the issues, and I will decline any opinion when I am not so qualified.

What makes Mr. Boone put his feelings on this issue in to print in this forum but to twist people like me to disregard the truth over peripheral issues? Every podiatry expert witness should be outraged by this. I believe that Mr. Boone's reaction over the circumstances of the case he cited and my response, explains in part the disdain that physicians feel for attorneys on both sides of the malpractice aisle.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@msnyuhealth.org

RE: Sterilizing Non-Surgical Instruments (Robert Spalding, DPM))
From: Elliot Udell, DPM

Dr. Spalding makes a good point. Autoclaving is time consuming but the use of gluteraldehyde so that it properly sterilizes instruments also takes a great deal of time. A busy podiatry practice where the practitioner is taking instruments out of the solution, putting them back and reusing them less than five minutes later cannot promise that disease will not be transmitted from patient to patient. Also the solution sitting in a treatment room cannot be monitored as an autoclave can. Solutions have shelf lives and they lose their efficacy with use.

If we are to convince the public and ourselves that we practice on a higher level of professionalism than pedicurists in beauty salons, we have to autoclave our instruments.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

PRACTICE FOR SALE – FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. email response to podfootdocs@aol.com

ASSOCIATE POSITION-INDEPENDENT CONTRACTOR – FLORIDA

High Income position for ethical hard working podiatrist, great for semi-retired or to supplement office practice, part time. Must have Florida license and active Medicare/Medicaid numbers. FAX CV or Resume to 727-785-4697

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established podiatry practice in Mt. Airy, North Carolina that is either for sale or in need of an associate/partner to come on board to take over patient care. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3,500 patients without a podiatrist to care for them. This is a unique opportunity to be able to begin work in an extremely busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

EQUIPMENT FOR SALE

Merging practice and I have an office full of equipment for sale. No reasonable offer refused. Great for new practitioner or second office.Two older PDM treatment chairs. One surgical table, also great for orthotic casting. Variety of hand surgical tools, waiting room chairs, cast cutter, etc. Call and ask! Need to clear out office by Nov 1, so I'm motivated...Paul Busman DPM Troy, NY 518-272-6881, 518-229-6668 Cell.

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