Who Wants $125 Million?

Six years ago an initial round of audits found that Medicare had potentially overpaid five of the health plans $128 million in 2007 alone.  This all deals with the Medicare Advantage Plans.  In the end, how much did they settle the audits for in 2012?  Just under $3.4 million.

Personally, I think this proves a couple of points.  One, it shows how impotent or poorly run the government is, in regards to healthcare.  But heck, it’s your money and not theirs so they don’t care.  Second, it shows that they cannot pin anything to those doctors who “upcode” to charge Medicare more money.   The whole coding system is a joke.  You have heard of the ICD-10 debacle but this is different.  The way doctors code is to add as much fluff to the medical chart to make it sound more than it is.  With the help of the EMR it is very easy and a total scam.  Each little bit of information makes the documentation more worthy of a higher bill albeit less valuable to anyone reading it.

You can read the article linked about and see how the story turned (fizzled) out.  Nothing will be done. Another loss for our tax dollars.  Can’t we just have a system with transparent costs?  It really isn’t that hard.  The one we have now doesn’t work.  In my opinion, if these Medicare patients were told of the price of their services prior to receiving them and had to pay it themselves then this would be another story altogether.  No group of patients complain and haggle harder than the elderly.

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] 

  5 comments for “Who Wants $125 Million?

  1. Mary Lang Carney, MD
    January 14, 2017 at 9:30 am

    Thanks for all your commentaries.
    Recently decided to join MDvip I think it will help me continue in my solo primary care. I got so far behind in submitting my charges because I could not continue to see 18 patients a day and write my notes type in EHR, could not longer sustain it.
    I am surprised that my patients will stay with me.
    Cannot keep up with documentation, forget meaningful use. Dr Sinsky has to have more than one medical assistant to keep the flow going
    Have worked in my career for a staff model HMO for 10 years, worked for a hospital for 10 years and in private practice for 16 about 7 solo. Trying MDvip now. Will see how that goes

  2. MCW
    January 11, 2017 at 11:07 am

    The government has never had a handle on medicare fraud. In the 70’s some GI’s bought colonoscopes for their offices. A colonoscopy back then was defined as examination of the colon above 25 cm (the length of a flexible sigmoidoscope). Put in a colonoscope to 26 cms, remove a miniscule polyp with a tiny biopsy forceps and bill for a colonoscopy with polypectomy, then paying about $900 (now $200). Later I did procedures in an outpatient center with over 10 other active GIs on staff. One Doc sometimes did more colonoscopies per annum than the rest combined and was always an outlier. Most of his patients got an EGD as well, but always on another day. When he received letters to appear before the executive committee all members immediately received letters from his lawyer threatening lawsuits against them. In both of these examples early identification of outliers followed by audits and prosecution could have nipped this in the bud. This is the result of government ineptitude and insurance company greed. These problems need to be addressed at inception, not several years and billions of dollars of fraudulent, overinflated claims down the road.

  3. Soccerdoc11
    January 9, 2017 at 8:19 pm

    I received a “second request” from United Health Care for return of two overpayments of $10.88 each from July 2016 this week. Fortunately I had records showing the repayment months ago. Medicare could give away over $100 million, while I get nickel and dimed for chump change twice. What a system!

  4. Pat
    January 8, 2017 at 11:18 am

    This illustrates the core fallacy of a Medicare. The retirees are NOT hagglers and cost cutters when it comes to controlling the inflated, fraudulent costs of a program that has been sold to them as a right. Moreover, most shuffleboarders that I talk to actually believe that the money they have paid in should cover their expenses, and are oblivious to the price inflation that Medicare causes, and that it has never been actuarialy sound.

  5. Seneca
    January 8, 2017 at 10:15 am

    Absolutely right. We will never get costs under control with a “top down” command system now favored by CMS. The elderly (and their daughters) could certainly be enlisted as the best cost cutters in history!

Comments are closed.