Medicare Fraud

Finally, the government is getting on the ball by finding, arresting and prosecuting the doctors who abuse our Medicare system.  The recent arrest of 108 doctors, nurses and other healthcare providers from around the nation was impressive as they had bilked the country out of $455 million, which was the highest amount of false claims pursued in a single raid in the history of a federal strike force.  Great job.   That being said, I still fear that this success may make the government officials in charge too cocky.   Our system for coding office visits is a mess and has always been confusing.  Many times doctors overbill by mistake on certain visits or because their documentation didn’t meet the requirements by an auditor (very subjective).   As these strike forces get more brazen they will start overdoing their job and try to net perfectly honest doctors.  Want proof?  A new Medicare proposal is requiring doctors to go back through up to 10 years of medical records to determine if they received excess pay.   Ten years!   It sure looks like the consequences of innocent mistakes by physicians and practice administrators may “be swept up by rules aimed at those knowingly committing fraud and abuse”.   This will just make more and physicians not take Medicare/Medicaid patients in the future.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Medicare Fraud

  1. May 7, 2012 at 11:44 am

    Thank you so much, Pat, for again reminding us that the AMA physicians who in the 60s decided to turn over their ability to make decisions about their patient care to Medicare in return for a few promised shekels launched this whole health care landslide into the dumpster.

    That was long enough ago that a lot of people today, including physicians, have no memory of it. A couple more decades, and there won’t be any physicians left in practice who remember what it was once like.

    I do become irritated at the media and the medicare fraud units for blaming physicians time after time, and not the corporate entities which sponsor the practitioners who are blamed. Some of these vilified practitioners may be independent, but I’d like to see how many are associated with corporate medicine.

    A May 2, 2012 article in the LA Times just blames physicians for medicare fraud. I rarely see these fraud articles looking deep enough to find out whether physicians are independent or working for corporations. If they work for corporations, it’s not mentioned. It should be.

    What’s worse, this kind of reporting simply riles up readers to the point that those making comments suggest shooting the doctors. Wonder if these readers would recommend shooting a CEO?

  2. May 6, 2012 at 1:28 pm

    Any physician, depending on the mood of the auditor, may at any time be deemed guilty of Medicare fraud. This is the logical, reproducible result of a bloated program that itself is based on a completely fraudulent idea. The biggest criminals of all are the doctors who should have stopped this cold in the 1960’s, but took the cash and began an unethical relationship with big government which now I and most other providers perpetuate. We are all guilty now.

    • Elwood L Schmidt,MD
      May 10, 2012 at 9:37 am

      I was one of the doctors practicing in 1965. Almost every single doctor that I knew entered the program under protest, and continued to protest the intrusions into medical care. Who are the people you refer to when you say their was a sellout???

      • May 11, 2012 at 3:06 am

        Then sincere compliments to you sir! Nonetheless, the reading I’ve done indicated that the AMA, far more representative of the rank and file in those days, dug in hard against Medicare; then after the famous Wilbur Mills “I can quote” remark, spun on its collective heel and has supported it since. Other docs from that generation with whom I’ve spoke have agreed with my assessment though, I welcome your insight even if to the contrary.
        What were – if any – protests? Was it a dictate handed down at that point immediately from hospitals and universities? Did any hospital board to your recall try to refuse Medicare, or sue for non participation independence?

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