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6. Troubles and Trials
- The University of Alabama Press
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6 Troubles and Trials It was about 1970 when Medicaid came to Alabama, and when you think about it, it should have been a good thing for me because Medicaid was supposed to help poor people pay for medical care. That should have helped my situation, but that’s not the way it turned out. It was the start of a lot of trouble for me. For one thing, it was hard to keep up with the paperwork. We had some patients with no insurance whatsoever; we had some with Medicaid only and some with Medicare only; and we had others with a combination.We had those four categories, and we had to try to remember that when we filled out the claims. That extra paperwork affected how you dealt with the patient. If you spent ten minutes with the patient’s examination, then you’d have to spend at least five or ten minutes filling out the forms, especially those of us who didn’t have the new technologies in our office. In retrospect, my informal way of doing things wasn’t the best way to go about it, and certainly some of my record keeping was not up to par because I did not keep the records in every single instance, 100 percent, like they should have been. By the mid-1970s, I think about 75 percent of my patients were on Medicaid , and I believe I was the only doctor in town that had that figure. Others didn’t even approach it. In fact, some of the physicians had said initially that they were not going to accept Medicare and Medicaid patients. Dr. Drake had expressed that thought. He finally did, but neither he nor Dr. Belle ever had the volume of Medicaid patients I had. And many of the Caucasian physicians never did accept Medicaid patients. There were about four of us in the whole state that were the top providers of Medicaid. Because of that, we made more Medicaid income than the other doctors. I was probably number three or number four. But when you scrutinize it, you’ll see that Medicaid was about four-fifths of my total income, whereas, 128 / Chapter 6 with some of the other doctors, it may have been 10 percent of their total income . My patients were poor, and they’re the ones who had Medicaid. One morning, I got up and went out on the driveway to pick up the newspaper , and there on the front page it said that there were doctors who were making a fortune off Medicaid and that the previous year I had made $85,000. And they were right, because that was the bulk of my practice. I collected $85,000 from them, and my overhead was probably $60,000. So my net was about $25,000, and when you take income tax from that, I really wasn’t making much money. Some people would meet me on the street and say, Dr. Hereford, I didn’t know you were making that kind of money. The fact that I seemed to be making money off a program meant to help poor people—that’s probably what got me singled out when the time came to cut costs. I’ve thought about all this a lot since I lost my license, and I think that was one of the reasons. It probably didn’t help matters that I enjoyed gambling occasionally.My wife and I used to go to Las Vegas pretty regularly, and then we’d go down to the Bahamas because we loved to play Black Jack, you know. At first, we just liked to play slot machines. We would sometimes go to Las Vegas, and we used to go down to Puerto Rico. Some people actually saw me in the gambling places.They were there gambling themselves. And some other people had heard that someone had seen me there. And then, maybe they had called for an appointment and the answering service referred them to my alternate doctor who was covering for me, and they may have become disgruntled on that point—well, you know, he’s not here, and in my opinion, he ought to be here. But I was only away on my off days. Not every single off day. It was once or twice a year. And then finally, there was one point where I would go once or twice a month. When my Medicaid problems started...