While senior citizens may suffer consequences of possible insufficient Medicare, who is to blame? Let’s check it out.
In a NY Times Sept. 22, 2012, article, Medicare Bills Rise as Records Turn Electronic we see that it is the doctors and hospitals that are causing a rise in Medicare costs. (I have added boldface for emphasis.)
Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms…
The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone.
hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments at higher levels from 2006 to 2010, the latest year for which data are available, compared with a 32 percent rise in hospitals that have not received any government incentives
The article goes on to show how easy it is for doctors and hospitals to fraudulently use a code that means, for instance, you had a full physical, where in fact perhaps a doctor simply poked around in your abdomen.
However, this enormous amount of fraud means that down the road the consumer, you or I, will not be able to a) have complete coverage via Medicare, or b) have to pay for any coverage beyond the bare minimum. Of course, you have been paying about 1.5% of your income your whole working life in order to get coverage during your older years.
In New Hampshire, the Dartmouth-Hitchcock Medical Center (DHMC) has paid $550,000 this year, and over $2.2 million last year, in fines to the federal government because of overbilling by certain departments for Medicare and Medicaid. That hospital was caught being fraudulent.
What happens to hospitals and doctors that get away without being discovered? Nothing! But what happens to coverage for you and me? Over time it gets reduced.
Overlook hospital in Summit, NJ, was fined nearly $9 million after an employee whistleblower let the federal government know that Overlook had
overbilled Medicare by billing for patients who were treated on an inpatient basis, when they should have been treated on an observation or outpatient basis.
“Billing Medicare for unnecessary inpatient services steals from taxpayers,” said Daniel Levinson, inspector general for the U.S. Department of Health and Human Services (HHS). “Although that’s bad enough, it also requires hospitalizing people who don’t need it, causing inconvenience, discomfort and worse.”
That same article said
Since January 2009, the Justice Department has used the FCA to recover more than $7.7 billion in cases involving fraud against federal healthcare programs.
My advice: double-check and triple-check bills that you receive after a medical visit, either inpatient or outpatient. In our family, we caught an overcoding/overbilling for a hospital visit, and complained to the hospital director that this appeared fraudulent. Many apologies came our way, and the billing was subsequently made more honest. So you can do this, too!
It is too easy to penalize the patient, the consumer, when in fact it is other parts of the healthcare system that are putting Medicare into a poor financial condition.