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