Beware of Large Egos

Beware of Large Egos

When hiring consultants or compliance or legal professionals, ego, often insecurity in disguise, can cause big trouble. People who feel a strong need to prove themselves right or look smart will often forget to prioritize the needs of their clients/employers. 

Let me be clear: this is not a broad indictment of consultants. I’m a strong advocate of engaging consultants and counsel to improve your compliance and billing processes. Outside eyes can spot mistakes, teach you about rules you are not familiar with, and provide useful process tips. 

Many of the cases I am in are won by a smart consultant, not by lawyering. In short, you want to engage outside consultants and attorneys. But I’ve seen far, far too many situations in which a consultant’s report is poorly worded, resulting in a product that can be used as a bludgeon to hurt you. 

Sometimes the poor wording is a product of carelessness or incompetence, but often I fear it is a consequence of the consultant’s attempt to show off. While it’s entirely acceptable when a peacock chooses to preen, it’s not behavior you want in either an external or an internal reviewer. 

Let’s look at a concrete example.

Say a report offers the direct criticism “the codes you selected were wrong.” It also offers some detail: “we changed an incorrect PEDX to a cancer code for specificity, changed a mistaken observation to inpatient admission, and added codes to correct your mistakes.” 

Compare that with “we would suggest you consider different codes on several of the claims.” Perhaps those two sentences sound substantially similar.

In both cases they are offering thoughts, but there’s an important distinction. The use of the word “suggest” completely transforms that second sentence. It is so much softer, and acknowledges grounds for disagreement. 

In most situations in life, I advocate for very direct communication. But critical consultant reports are an exception. I want the criticism presented, but I don’t want it to be worded in a way that destroys your defenses if the topic becomes part of a government investigation.

Imagine if the report began with “coding is often more art than science. People may disagree about particular codes. We are offering the following recommendation, though we acknowledge people may disagree.” Adding that little bit of humility (or more accurately, acknowledgement of reality!) makes it much more difficult for the government to use the consultant’s report as a roadmap to accuse you of fraud.

My point is that a gentle “I might word that slightly differently” is far superior to “that code was incorrect.” In a chart providing data, softer headings like “we agree with your code” or “we would recommend a new code” are far superior to shorter, blunter labels like “code is correct/code is incorrect.”

An expert’s purported confidence may cause you to initially conclude that they are more knowledgeable and expert than you. But truly confident people are comfortable acknowledging uncertainty. 

And perhaps more importantly, good consultants and lawyers will work hard to make sure they’re making you look better without exposing you to unnecessary risk. When you’re getting reports from consultants or lawyers, make sure that they’re wording their advice in a way that won’t be used against you. A blunt “you are wrong” is NOT helpful. 

One final story.

I recently had a situation in which we called a state department of health to confirm that a transaction wasn’t a “change in ownership” requiring a report. The state agreed. Another lawyer on the deal, who had told his client it WAS a change in ownership, had a bruised ego. So he called the state and argued with them, trying to convince the state to flip their position and require ours to go through additional review.

That lawyer, in order to prove himself right, was willing to hurt his client. That’s crazy, but I wouldn’t call it rare.

Not everyone is willing to, dare I say, “leggo their ego.” 

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David M. Glaser, Esq.

David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.

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