Cliff Blake shows where a nail entered his foot, causing him pain and continued anguish as he fights a doctor's bill.
That was for an hourlong visit with John S. Lanham.
The Milwaukee podiatrist performed an array of procedures, gave Blake a cortisone shot and sent him out the door with an armful of foot and ankle support products.
His foot still aching a week later, Blake went to see a different podiatrist. That doctor did fewer tests but many of the same procedures. The bill came to $315.
Blake isn't the only person to question Lanham's charges.
A few years ago, patients complained about Lanham's high bills to the state podiatric society. That prompted an investigation into the doctor on suspicion of fraudulent billing. The state eventually suspended him for 90 days.
Lanham's suspension ended in April, one month before Blake's visit.
Now that he is back in business, Lanham continues to charge far more than other podiatrists, the P.I. Team found after checking with other local doctors. In one case, Lanham charged $1,700 for medicine that costs $15. Other podiatrists have questioned his charges, too, and were just as shocked as Blake by Lanham's bill.
"This is so far out of the norm, if I wasn't looking at it, I wouldn't believe it," said Steve Kaufman, the podiatrist who treated Blake a week after Lanham.
Lanham referred questions to his attorney, Joseph Fasi, who said his client has done nothing wrong.
The podiatrist has "very high" charges, the attorney said, but there are no rules or laws governing doctors' fees.
"A person can charge whatever they want to charge," Fasi said.
The amount that matters, he said, is what insurance companies pay a doctor for certain procedures.
That's only the case, however, if a doctor is in an insurance company's network.
Insurance companies negotiate discounts with doctors in their networks and pay a set amount. Patients such as Blake who visit doctors out-of-network don't get those discounts. They are responsible for paying the portion of the bill not covered by insurance.
Uninsured patients are responsible for the entire tab.
Since returning to practice, Lanham has taken at least nine former patients to small claims court to collect fees. He has won some cases; others are pending.
Not in insurance plan
Blake found Lanham by flipping through the phone book. He knew the doctor wasn't in his insurance company's network but didn't think a visit to the podiatrist would cost too much. A meat cutter at Pick 'n Save who also delivers papers as an independent contractor for the Journal Sentinel, Blake has been to doctors many times for puncture wounds - just a hazard of his meat-cutting job. He figured he'd have to pay only $300 or $400 for a visit to the foot doctor.
That is generally what a visit would cost.
Doctors have "usual and customary fees" that they charge for certain procedures, said Steven Frydman, a podiatrist and director of the Wisconsin Society of Podiatric Medicine. Doctors working in and out of network stay within a fairly close range of those fees.
"You can't just pick a number out of the air and charge it," Frydman said. "There has to be some rationale."
For Blake's bill, Lanham charged $850 for cortisone and $850 for the medicine used to numb his foot.
The cost of those drugs?
At most, $15, local podiatrists said. That's also the amount they'd charge.
Lanham also charged $85 for two sterile syringes with needles.
Those products cost about 10 cents, podiatrists said. Most doctors don't bill for them or charge $1.
The P.I. Team asked five local podiatrists to review Blake's bills and medical records. The doctors found additional problems with Lanham's billing.
He billed $265 for a "new patient fee." That's at least twice what most podiatrists bill, Frydman said.
Lanham charged separately for supplies, including the syringe and medicine, as well as the injection, instead of billing one price for the shot.
The podiatrist's billing procedures are not new to the Wisconsin Society of Podiatric Medicine, a trade group that developed a code of ethics for its members. That's the group that investigated Lanham a few years ago after complaints rolled in.
Lanham quit the society during the investigation, said Frydman. The investigation was then turned over to the state.
"He has been cautioned by people in my profession to stop overcharging," said Steven Waldman, a podiatrist in New Berlin. "He has had a number of opportunities to change what he's doing, and he just hasn't."
Lanham's attorney said he is not aware that any other podiatrists contacted the doctor about billing.
Most of the complaints to the society came from patients whom Lanham pursued for the portion of the bill not paid by insurance companies, Frydman said.
Shelly Pohlman was one of those patients.
She said Lanham demanded payment after her insurance company paid only $2,700 of a $7,000 bill. Pohlman visited Lanham two years ago after pulling a ligament in her right foot.
Lanham took X-rays and did an ultrasound. He also gave her a cortisone shot, a foot brace - and, a few weeks later, a $7,000 bill.
The bill included $175 for two syringes and needles, $999 for cortisone and $1,099 for the medicine to numb her foot. The podiatrist also charged a $499 new patient fee - nearly twice what he charged Blake.
Pohlman said she negotiated with Lanham's attorney until he accepted $480.
Fasi said Lanham's high costs are no different than a law firm's charging $700 an hour and another's charging $300 an hour for the same work. Or no different than Starbucks charging $3 for a cup of coffee.
One difference is that Starbucks' prices are posted on the board in every store, Frydman said.
Jack Meler, president of HealthCare Direct, said Blake's problems with Lanham's bills show why some people are pushing for more transparency in medical costs.
"If this guy had been told it was going to cost $4,000, he would have limped out of there," said Meler, who runs a health plan that supports price transparency.
Suspended by state
Lanham was suspended 10 months ago after the state said he created false bills and submitted false claims to insurance companies. In its investigation, the state found that the podiatrist billed for procedures he did not perform on patients, according to a final decision and order filed by the state.
In settling with the state, Lanham denied that he knowingly submitted false claims for payment. He did acknowledge that he had "reckless coding errors in his billings," according to the stipulation.
Lanham was required to pay the state $26,739 for the costs of his case. Fasi said Lanham agreed to the stipulation instead of spending time and money fighting the allegations.
The state has received 33 complaints against Lanham since 2001, according to the Department of Regulation and Licensing. The agency considered 13 of those in its disciplinary action.
Lanham has never been accused of harming a patient or giving substandard care, his attorney said. The state's decision to settle with Lanham - and consider just 13 complaints, not 33 - proves that the case was weak, Fasi said.
"If they were right, they wouldn't have settled for a three-month suspension," he said. "They would have gone for his license."
Lanham is the only podiatrist who has been disciplined by the state in the past five years, according to the regulatory agency. No podiatrist has had his or her license permanently revoked in the past decade. One voluntarily surrendered his license.
Blake said he is still angry about Lanham's bill and won't pay it, especially as the amount keeps fluctuating.
On Wednesday, Blake received an updated bill from the podiatrist requesting $956, his share of the total bill. Lanham had removed five charges and lowered the bill to $3,458. Fasi said the bill might have been lowered because of what Blake's insurance company agreed to pay.
UnitedHealthcare, Blake's insurance company, has paid part of the bill using $970 of Blake's health reimbursement account. Blake said he'll try to recoup that from the podiatrist.
Blake said he does not know if the insurance company will pay any more of the remaining bill.
"I think he's back to his old ways," Blake said. "He's just taking insurance companies and people for a ride."
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