I am a former Kaiser employee who wore the badge and title of “Auditing Specialist”. My qualifications for wearing this badge included the fact that I was an Registered Nurse (for over twenty years at the time of my employment with Kaiser) and a certification of CCS-P (certified coding specialist) attained through intensive studying of the codes used for diagnosis and treatment of all diseases recognized by the DSM-III manual (listing of all known medical problems/symptoms for which a person seeks medical treatment for improvement/cure of their distinctive problems that have been recognized by the American Medical Academy and the Health and Human Services department of our government. (There has probably been some changes in this manual since my employment, but the general concepts remain the same as the intended original.)

As an Auditing Specialist, I and my co-workers (some without the extent of qualifications that would seem necessary to perform this position) were responsible for reviewing the medical records for physician office visits to determine whether the documentation in the record “matched” with the patient’s presenting symptoms and/or chief complaints at the time of the visit. It may not surprise most of you that this “match” was rarely met (if you could even begin to decipher the physician’s handwriting!). Office visit notes were scribbled at the time of the visit (probably no longer than the 5-10 minutes allowed per patient to ensure that the MD could see the maximum number of patients in ant given day).

If a diagnosis was even mentioned in the record it was an unusual occurrence. Treatment plans usually consisted of “return to clinic PRN” which means “as needed”, leaving the decision of whether further medical testing and/or treatment was “needed” to the discretion of the patients and significant others rather than to the physician to whom this responsibility is given at the time they take the Hippocratic Oath to “at first, do no harm.” While giving this responsibility to the patients, Kaiser was able to delay, postpone or make extremely difficult, the ability for the patient to make return appointments or receive a referral to appropriate consulting and treating specialists. Urgent Care employees, when questioned about the lack of appropriate documentation in the medical record, were not surprised, nor were they the least bit supportive of, the manner in which the physicians conducted and documented these office visits!! Given the opportunity to vent their opinions, it was apparent that most of the employees had very little faith or confidence that the patients were receiving the appropriate care in a timely manner (remember, each “visit” was limited to 5-10 minutes — if a patient could not express themselves clearly or did not have the ability to speak quickly and to the point about their symptoms, they were in the hallway, after seeing their doctors,looking dazed and perplexed about what to do next!!).

In many instances, they were not even seen by MD’s, but rather by the Nurse Practioner in that particular MD’s office. (Drop by the Kaiser outpatient offices at The Orchard Medical Offices in Downey, CA (Southern California Kaiser Permanente Medical Group) and you will see a steady stream of patients at all hours of the day and night!)

It would take reams of paper to even give a synopsis of the types of “errors” noted in the medical record and the corresponding charges requested by the MD. Yet, when these discrepancies were addressed in our audit reports, we were instructed by our supervisors and upper management (including the esteemed Medical Director of the group practice) to “find a way” to justify the charges or “look at it another way”. It is my firm belief that Kaiser has charged for services that were either not provided or where shabbily done. Let’s not even address the co-payments required by patients, to be paid at the time of the visit, or be charged an additional $15.00 for the privilege of being billed at a later date.

As you may have gathered by now, I am no longer employed with Kaiser and if I had not resigned my position, would probably have been fired for my thorough review of the records I reviewed. I did not hesitate to speak loudly and frequently about the discrepancies I had found — and, as such, was not viewed as a valuable asset! (In fact, I had been “disciplined” and given poor performance evaluations for essentially doing the job that was required of me — audit for the complete and accurate documentation in the medical record).

I had been, until 3/1/08, also been a Kaiser enrollee, receiving all my medical treatment from Kaiser physicians. I remember one time very clearly, after one of my “scheduled” appointments with a primary care provider, literally screaming at him regarding his lack of attention, while he showed me to the door. Didn’t do much good anyway — I had joined the Kaiser sheep fold and literally had no real recourse available to me. I admit that I held on to my Kaiser benefits for a long time simply because my employee benefits far surpassed any other type of insurance I could have obtained. My co-payments were ridiculously low!! I had surgery 3 times for recurrent bladder tumors, and paid only $5.00 for all of the inpatient services I received — including surgeon fees, anesthesia, medical supplies, and any other associated costs. How did Kaiser manage to keep my charges so low?? They were able to do so only because of the majority of their enrollees were paying upwards of $700 per month for their insurance benefits. To say that my health care was subsidized by the silent majority says it all!!

I must apologize for generalizing and making it appear that ALL Kaiser physicians acted as depicted above, for I was fortunate to receive treatment from some very qualified and professional physicians — but, because of my auditing experiences, I knew which MDs met their responsibilities and could selectively choose whom I entrusted to care for me. It is with deep regret that I acknowledge that the majority of Kaiser enrollees do not have the advantage of this knowledge, and are made to endure the horrific experiences as outlined by Ms. Stein and others who have posted comments on this invaluable Web site.
I am afraid to say that the only ones who “THRIVE” at Kaiser are the physicians who comprise the FOR PROFIT medical groups!!

I also apologize for this lengthy post and would like to thank everyone who had the patience to read it in it’s entirety–
I wish all current and past Kaiser enrollees the opportunity to have their medical needs addressed in a timely manner by professional and competent health care individuals. Alas, I cringe to admit, this may be possible only OUTSIDE OF KAISER!!

Best wishes to you all,
CTJ

I hope you get the chance to read this and I hope that everyone else who reads my comment and has been a Kaiser victim will make a stand and not be afraid to RIOT outside their door.To NOT be afraid of sueing this place for all they have. You need PROOF,DOCUMENTS,(recordings would be SOOO awesome!), whatever you can get your hands on, and go to court.

This cannot go on. They’ve been in business way too long.

My deepest sympathy goes out to you,
in Him,
Hannah

I sent him an email one time, and he actually responded. The email I sent detailed how my wife was ‘treated’ at a Kaiser facility.

His response? ‘That can’t be Kaiser.’

The sad thing is, he’s the one who is pushing for universal health care. He’s the one leading the charge. If he gets his way, we may as well all just take a cyanide pill.

Yep I’d say, this just validates your existence Admin.

Keep up the excellent work! Our safety depends on it.

[editor's note: This lovely human being accessed from Kaiser Permanente IP address 162.119.64.113, via a Yahoo search for *Timothy Wild MD* at 12:33pm Pacific time. Dr. Wild himself doing a vanity search, perhaps? Or maybe just a co-worker who likes to impersonate Harvard doctors, that suffers from some sort of bizarre fixation on "hottie" Dr. Wild. Thanks "Pam" for another stunning example of the sociopathic lack of compassion Kaiser's health care "professionals" have for their victims. Keep up the great work...makes our job here much easier.]

Let me add that your gift for remote diagnosis of a patient you’ve never even met is truly remarkable. You oughta take that act on the road. (Unless of course you have met her, which just makes you a creep).