Surgery Center of Oklahoma Blog

August 7, 2011

Medicare Fraud

Filed under: Medicare — surgerycenterok @ 3:39 pm

If I didn’t know better I’d say that someone from our local newspaper is reading this blog.  In the Sunday paper there was one article on Medicare Fraud and another on un-needed scooters for the elderly!  In the last blog on private contracting, I listed “risk” as one of the reasons that many physicians will no longer see Medicare patients.  In today’s newspaper, a U.S. attorney for the western district of Oklahoma was urging seniors to recognize and report Medicare fraud and abuse.  Sounds good so far, huh?  Half way through the article, seniors are told that if something doesn’t make sense on their bill or statement they should contact the Medicare fraud hot line.  Starting to get the picture?  Are you imagining thousands of confused elderly people calling this hotline because something doesn’t make sense to them?  Do medical bills make sense to anyone?

Now put yourselves in the shoes of the physician (perhaps a neurologist or an internist specializing in geriatrics).  They have lots of patients that are confused on a good day.  They are being encouraged to call the Medicare fraud hot line.  The storm-troopers arrive at the physician’s office looking for “fraud and abuse.”  They will find it.  A simple mistake on one out of tens of thousands of forms will be found.  This will be determined to be fraud.  Why?  Because that is what the thugs from Medicare are hired to do….they are just doing their job, you know.  The physician can fight this in court (and face certain bankruptcy trying to win this case against the leviathan) or he/she can surrender and pay the fines/penalties and settle up with those in charge of this extortion/shake down/stick up…whatever you want to call it.

When you read that Medicare fraud is on the rise, it is because Medicare and our wonderful public servants in the Dept. of Justice say it is on the rise, not because it is, necessarily.  ”Physicians surrendering to bogus charges of fraud rather than face bankruptcy is on the rise,” is actually more accurate.  Is there fraud in Medicare?  Of course there is.  There is fraud in all types of insurance.  This is the nature of having third parties pay bills, rather than those receiving the product or service pay the bills.  How about this?  ”Dr., I’m writing my check for today’s visit and you have charged me for a urine check that wasn’t done and I don’t want to pay for what wasn’t done.”  Isn’t that where the accountability should be?  Dr. says,” I’m sorry.  I checked that box and didn’t mean to.”  Or alternatively, the physician says,”Nurse!  Why didn’t you get a urine sample like I asked you to?”  Could this be interpreted by the Medicare police as fraud?  Yes it could.  Yes it has.  Physicians are in jail for this kind of stuff.

“Doctor?  Can’t you do a full blood workup on me?  I know my last one was a month ago but I sure would like to have that re-checked.  It’s not going to cost me anything ’cause Medicare will pay for it.  Just go ahead.”  Is this fraud on the patient’s part?  ”I see other folks riding around on those scooters at the grocery store and I can’t afford one but my buddy who has the same Winnebago I do said that if you will just write me a prescription then Medicare will give me one.”  Only when patients are responsible for payment of their care will the incidence of fraud and abuse on both ends decrease.

How about this for fraud?  All of the money that people have paid into social security and Medicare over the years is gone.  Now that’s fraud and abuse.  Hospitals increase prices for those of us who are paying to “cover” those who can’t pay……all the while knowing that they will be paid later for this “free” care….now that’s fraud.

I predict that fewer and fewer physicians will see Medicare patients as demented old folks light up this hotline with items that “just don’t make sense” on their bills/statements.  Most of the elderly will never understand that recruited as brownshirts, they may completely lose access to the physician that has taken care of them.

G. Keith Smith, M.D.

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