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February 26, 2013 09:59 PM

The Price Of A Practice

Sioux Falls, SD

She was on the brink of losing her medical license and at the center of a Medicaid investigation.  Sioux Falls Doctor Annette Bosworth has cleared those hurdles, and her name, and she now wants to move forward as an independent physician serving the under-served.

Bosworth doesn't want to be like other doctors in a city full of physicians. In her new Sioux Falls office, Bosworth is building her practice called Meaningful Medicine.

"When you are in the industry where you take an oath to serve people and do that to the best of your ability and considering their needs first and foremost, I think the time spent with a patient has to be remembered," Bosworth said.

"She cares more about her patients than any doctor I ever met by miles," Meaningful Medicine patient Stacy Seigfred said.

Bosworth wants to change the way doctors connect with patients, not only by using more technology, but also by spending more time with them.

"She follows up. She gives you time. I have never, ever felt rushed through," Seigfred said.

As an independent doctor, Bosworth can do that in a city dominated by two large health systems.

"And in the bigger systems, there is a production base that it is difficult to have that lengthy time spent with patients and still be able to meet the overhead needs that are ingrained in a system," Bosworth said.

But in the last 16 months, it seems as though Bosworth has been spending more time fighting to keep her practice open than seeing patients.

"The sheep that is outside the pack can be easily pointed at, can be sequestered, and then they are alone," Bosworth said.

In late 2011, Bosworth was helping serve the poor in shelters across Sioux Falls. It was work inspired by her half-dozen trips to Haiti where she had done similar work. But just as her attorney, the late Governor Bill Janklow, was announcing his own medical problems, Bosworth says state Medicaid investigators came knocking on her door, asking questions about billings from the shelters she had been working in.

"The cases that were focused on were children without parents and I was giving them the same care I would have given anybody in my clinic. But this was a point of attack and I can't make sense of it and it's my story," Bosworth said.

The state alleged that Bosworth was submitting claims for non-covered services to children under the age of 19. When the investigation began, it halted any Medicaid payments to Bosworth.

That wasn't the only allegation against Bosworth. The state Board of Medical and Osteopathic Examiners issued a reprimand of Bosworth, charging her with employing an unlicensed physician assistant without the proper supervision agreement in place while she was working in the Sioux Falls shelters.

After the board alleged that Bosworth didn't meet all the conditions of that reprimand, a hearing was held in November where Bosworth had to fight to keep her medical license.

Bosworth was able to keep her license and in the last month has also settled the Medicaid issue without admitting any wrongdoing. But she says the price to keep her practice open has been costly.

"I've paid a way higher price than I need to. My family and I live in an RV on 12th Street and it was four degrees below zero last night," Bosworth said.

The doctor who was serving the homeless is now homeless herself.  Bosworth says in the midst of the legal battles, she chose to keep the doors to her clinic open instead of keeping her home.

"That sends suspicion through all of your payers and the cash flow stops," Bosworth said.

While Bosworth did miss out on thousands of dollars in Medicaid payments during the year-and-a-half long investigation, the state Board of Medical and Osteopathic Examiners says its actions didn't cause insurance companies to stop paying Bosworth.

According to minutes from the board's December meeting, the board's investigator found that, "Dr. Bosworth is listed as an approved provider and can bill and receive reimbursement," despite the actions.

Though Bosworth no longer has any issues pending with the state, she believes she's been battle-tested.  She is ready to move forward in her new clinic and with her non-profit Preventive Health Strategies, which spent more than $400,000 before the state investigations began in 2011.  Those funds were used on programs to fight childhood obesity and medical mission trips to Haiti.

"I just continue to focus on what I can have control over, which is serving the one in front of me,” Bosworth said.  “Giving the best care I know how and hoping that through the process by opening up and being as transparent as I possibly can be that other onlookers can see there is a disconnectedness here about serving underserved patients.”

The independent doctor hopes she can make medicine meaningful again.

"By experiencing the pain I've had over the last two and a half years, the most profound thing that's happened is my passion is still very much alive," Bosworth said.

Bosworth hasn't done any work in shelters recently because of the Medicaid investigation, but now that the case is resolved, she would like to go back to doing that work.

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