Gunfight at the Medicaid Corral

The NYT did a nice summary into the federal government’s attempt to stop Medicaid fraud.  It is like they are gunslingers in a Western showdown.  I have blogged about this before and very much support it.  Unfortunately, it can be a problem when the government gets too aggressive and looks for petty mistakes.  Our medical coding system is a joke and interpretations of a visit can be very subjective.  Anyway, while doctors are investigated, the OIG puts a “payment hold” in effect and this basically destroys a physician’s income for three months.   While we need to stop these bad guys, this can be a problem for those good doctors unfairly targeted.  The VP of the Texas Medical Association said, “the only stunning thing is how little due process doctors targeted by Medicaid fraud investigations have. Right now, the office can look at a handful of charts, turn thousands of dollars in questionable billing into millions of dollars in estimated fines and penalties, and pursue a lengthy investigation, all while the doctor’s financing and needy patients hang in the balance.”   The OIG disagrees stating that “there are intentional acts and there are inadvertent acts, unknowing acts. We recognize the difference.” Geez, I sure hope so because I do want the bad guys flushed out and eliminated because they make us all look bad.  Lastly, I am concerned that the OIG has “redirected the office’s resources to put a greater focus on investigations with the biggest potential monetary returns and on Medicaid providers, not recipients”.  Why do we continue to let the recipients skate?   I understand that there are larger number of them and there is little you can do (to recoup much money) but c’mon, man! At least take away their Medicaid!  Abuse is abuse.  Stop discriminating on who the bad guys are.  They are all bad.

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] 

  2 comments for “Gunfight at the Medicaid Corral

  1. big picture doc
    July 26, 2012 at 11:04 pm

    We need good programs for the truly poor, but agree that the system is very much abused and fosters dependency and fraud.

  2. Pat
    July 21, 2012 at 5:14 pm

    A physician who miscodes is guilty of a fraudulent misuse of taxpayer money; a Medicaid patient with coronary disease who continues to smoke is not. A physician who spent more time with a government-dependent patient than he can justify is guilty of a fraudulent misuse of taxpayer money; a Medicaid mama on pregnancy number five, is not. In case after case, the presumption of bad behavior is assigned to the physician by virtue of him receiving money for work already done; this presumption is never assigned to those charity cases who believe they have a right to continue their own taxpayer-funded choices.

    Charity medical care administered at the federal level is philosophically untenable, a practical disaster, anti-physician, as well harmful to the best interests of the patient.

    And yet again, why I counsel any med student or doctor to find work for an hourly wage and separate themselves as much as possible from the consequences of this criminalizing program.

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