Audits For Medicare Providers
Feeling hungry? Head over to InsureBlog, where Hank Stern has put together a great Health Wonk Review, complete with a recipe for every article. And in honor or blog spam, all of the recipes contain Spam. Mmm… yummy! (I had no idea that desserts could be made from Spam. In my quest to learn something new everyday, today was a success).
The Colorado Health Insurance Insider article about the provision in the stimulus package to help laid off workers pay for COBRA was included in the HWR.
Dr. Rob, writing at Musings Of A Distractible Mind, has written a powerful open letter to the president regarding Medicare and the plans to audit primary care physicians to make sure that they aren’t defrauding Medicare. On the surface, it’s tough to argue against a program that aims to mitigate fraudulent behavior and save tax dollars. But Dr. Rob’s letter highlights the problems inherent in an audit system, and makes some very good points about the care that PCPs provide for elderly Americans.
I’m sure that there are some doctors and hospitals out there who are deliberately defrauding Medicare (and private health insurance companies). It is absolutely in the public’s best interest that the government find these providers and take whatever steps are necessary to reclaim money that shouldn’t have been paid, and prevent future cases of fraud. But I think that Dr. Rob makes a very good point when he says that most doctors are trying to provide the best possible care for their patients and simply get paid for what they do. Medical billing is fraught with complications and headaches. Mistakes will be made. If the government wants to eliminate mistakes, it seems that making the billing system less complicated would be a better solution than adding audits.
My father is on Medicare. He’s been on dialysis for nearly eight years now, and has had extensive medical care over the years. The vast majority of the doctors and hospitals here in Colorado that have treated him have been helpful and thorough. I’d hate to think that any of them might be considering abandoning their Medicare patients out of fear of government auditors. Stopping Medicare fraud is important. But implementing a system that makes doctors fearful of seeing Medicare patients is obviously counterproductive.
Louise:
Fraud is an area that needs to be assessed, in order to keep as many people as honest as possible.
Fraud goes both ways, both to Medicare and from Medicare.
As you probably know, the trust funds for Medicare and Social Security are filled with loans, rather than cash (or assets which can be liquidated into cash).
The payroll tax dollars are spent on other governmental expenses.
As an “insurer,” it would be foolish to conceive of a private sector entity leveraging its premiums and interest to pay for non insurance expenses.
Probably most people are aware these trust funds are filled with IOUs, so this behavior is not fraudulent.
What many people may not realize is that this “raiding” of the trust funds to pay for other expenses is legal.
The U.S. Supreme Court in Helvering v. Davis, 301 U.S. 619 (1937) states “The proceeds of both taxes are to be paid into the Treasury like internal revenue taxes generally, and are not ear marked in any way. Section 807(a), 42 U.S.C.A. 1007(a).”
“The first section of this title creates an account in the U.S. Treasury to be known as the Old-Age Reserve Account. No present appropriation, however, is made to that account. All that the statute does is to authorize appropriations annually. Not a dollar goes into the account by force of the challenged act alone.”
“Whether wisdom or unwisdom resides in the scheme of benefits set forth in Title 2, it is not for us to say. The answer to such inquiries must come from Congress, not the courts. Our concern here is with power, not with wisdom.”
Don Levit