David Robinson

drobinson@lohud.com

Gaps in government oversight and record-keeping suggest the marijuana program is ripe for fraud and abuse

Dr. Chin says there is no list of marijuana doctors available to physicians yet, despite pledges to contrary

Chin is among 445 doctors, of 90,000, who have registered in New York’s medical marijuana program

Dr. Junella Chin has a growing list of medical marijuana patients in New York, but she is worried about improperly charging insurance companies and taxpayers for their treatment.

Chin, a family physician in White Plains, is certifying marijuana patients and getting paid by health insurance companies and Medicare, the federal program for elderly and disabled.

Her concern is that 23 states, including New York, enacted laws allowing medical marijuana, but the drug remains illegal under federal law, suggesting it’s ineligible for Medicare dollars. Many health insurance companies also refuse to pay for marijuana because of the same legal ambiguity.

Some doctors circumvent the payment problem by charging marijuana patients consulting fees, typically $100 to $200 out of pocket. Chin, who doesn’t want to take cash, has been using health insurance and Medicare claims to get paid for the same type of visit, although she can’t sufficiently report the transaction because marijuana is not an option on many payment documents.

RELATED: Patients struggle to get medical marijuana in New York

“I feel like it’s almost like I‘m a pioneer, and I have to take that risk for my patients because I know it can be beneficial,” she said. “It is our duty, and we took an oath to help patients.”

Still, the gaps in government oversight and record-keeping of doctor fees suggest the marijuana program is ripe for fraud and abuse, which Chin discussed in an interview with The Journal News/lohud.com.

Chin is among 445 doctors, out of 90,000, who have registered in New York’s program since it launched in January. She spoke Wednesday after certifying 5-year-old Vincent Piperato, who has a rare form of epilepsy, and was featured in The Journal News story last week about thousands of critically ill people struggling to get the drug.

Chin has been treating patients with marijuana for more than 10 years in California, which legalized cannabis-based drugs in 1996. She moved to New York a year ago and vowed to keep treating patients with marijuana, regardless of the risk.

“Yes, I can lose my livelihood and license, but I’m hoping I don’t, and that they can figure it out at the state and federal level,” Chin said. “Why would they create a program and then prosecute physicians for it?”

Chin, who has 35 marijuana patients, also discussed why hospitals and universities are reluctant to participate in the program. She winced and shook her head while describing New York’s failures to sufficiently prepare doctors to handle medical marijuana.

Here are some of the questions and Chin’s answers edited for space and clarity:

Q: How are marijuana patients finding you?

A: I get most of my referrals from neurologists. I’ve certified about 35 patients, and I have a Manhattan office and one here in White Plains, and I get more referrals here. There’s more physicians that are registered in the program in New York City, but in Westchester County it’s not many. Some patients call me and say I’m the only one, but I don’t know because I don’t have access to other physicians that are registered.

Q: So the state Department of Health hasn’t made a list of marijuana doctors available to physicians?

A: Unfortunately not. I look every day, and I have had so many calls and was just looking and I couldn’t find it. I call the Department of Health, and they say they are working on a platform to publish it to other physicians so that we can refer it to one another, but unfortunately that is not the case.

(The state agency is also refusing to release the names publicly)

Q: Why did you start using marijuana to treat patients?

A: My practice is osteopathic manipulative medicine, and I use my hands to help heal my patients. It’s an integrative practice, and I talk about nutrition and we do different things … In the late 1990s in California, I had a mom come in that said, ‘I’m using something called medical cannabis and it’s working really well for Johnny’s seizures.’

I started looking into that and met other physicians and dispensary owners at a forum, and they started sharing stories and information because it wasn’t available anywhere else. I started integrating medical cannabis as part of the practice and started seeing the results and I’ve been tracking all the data that I’m learning clinically.

Q: What happened when you started in New York’s marijuana program?

A: A lot of colleagues of mine here cautioned me against registering. They would say, ‘The laws are kind of grey.’ But I felt I had to put my neck out there because I knew it was going to be beneficial to patients. How can you not offer patients the best care? And if New York actually put their neck out there by creating this medical marijuana program, I had faith that it was going to work itself out and my job was to help patients.

Q: Do you have any connections to New York hospitals?

A: I don’t have affiliations with hospitals, and I think part of that has been the saving grace. I just got here a year ago, and I noticed that if you’re affiliated with a hospital then they can kind of dictate whether or not you can prescribe medical marijuana to patients.

Solo practitioners like myself can navigate a little easier through the system than someone who works for NYU or Sloan Kettering because a majority of my referrals are coming from bigger conglomerates. I have patients in my Manhattan office that are getting chemo and radiation. They come to me saying, ‘My chemo doctor said this medical marijuana might be able to help me, but they can’t register me. Can you?’

Q: How are you getting paid for certifying marijuana patients?

A: I’m an out-of-network physician, and I’m not contracted with insurance companies yet. I got here a year ago, and applied to contract with insurance companies and that process takes time.

I give my patients an invoice and they basically submit it to their insurance as an out-of-network provider. I don’t put medical marijuana on it because of confidentiality purposes and basically it’s an office visit and most of my patients get reimbursed.

Q: What about insurance companies saying they don’t want to pay for medical marijuana because of the federal legal concerns?

A: There is no (insurance) code for medical marijuana, and so you’re coding for what the patient comes in for as a consultation. You code for his ailment, his disease, like any other visit.

Q: What about patients on Medicare?

A: I treat them and go through their medical history to determine they have an eligible illness…and I’ve done the exam and done the checklist for Medicare patients... (Regulators) can still see the chart and can audit the chart because I’ve coded everything that’s been done during the visit, but on the Medicare claim form there is no code for medical marijuana.

Q: But isn’t that a problem considering Medicare regulators use those codes to track other drugs as part of efforts to curb fraud and wasteful spending?

A: I didn’t think about that loophole, and I can see how that can be an issue, wow.