A Milwaukee, Wis., podiatrist has angered patients and frustrated regulators and the state podiatry board with his questionable business practices for a dozen years. So far, though, no one has managed to shut him down.
 
John Lanham is open about his habits, reports the Milwaukee Journal Sentinel: He allows patients to think his services will be covered by their insurance. It isn’t until they get his bill that they realize he doesn’t participate with their payers.
 
“How can I stay in business if I have to disclose to patients that I’m not in their network?” Lanham told the Journal Sentinel. If patients knew how much he was charging, he added, they’d leave.
 
In one case, a patient ended up with a $6,000 bill for treatment of an ingrown toenail. If insurance had covered it, she would have paid only $200 for a copayment.
 
Lanham, who later reduced the charge to $4,000 after the patient hired a lawyer, says that his fees are based on standard reimbursement rates for Medicare and other payers. He chooses not to participate with them because of their bundling policies, though. For example, most payers won’t pay separately for topical anesthesia to numb the skin prior to injection of medication and other component procedures of an ingrown toenail repair, he states. Lanham itemizes and bills for everything.
 
He claims not to be breaking any laws, but that isn’t exactly true. Lanham had his license suspended in 2006 as part of a settlement with the podiatry board over accusations of fraudulent claims. He admittedly takes a creative approach to code selection if he can’t find a code in the CPT manual that matches a service he provides he just bills for a similar service.
 
Lanham admitted to “reckless coding errors” agreed to have his claims monitored by an outside auditor under the 2006 suspension agreement. But, as the podiatrist told the Journal Sentinel, “it wasn’t reckless coding. I knew exactly what I was doing. The department just didn’t like it.”
 
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