New Efforts Underway to Reduce Medicare Abuse

David Lindsey, Attorney at Law

Doctors who have spent years abusing the Medicare system and overcharging patients could soon get a wake u call. The Obama administration has made changes that will likely put an end to years of abuse and reveal how much money individual doctors treating Medicare patients receive.

Dealing with Medicare Abuses

Unfortunately, even after doctors are offered extensive education for using the Medicare system ethically, some continue to take advantage of it. According to a recent story in the New York Times, habitual abusers will now be referred to Daniel R. Levinson, the inspector general at the Department of Health and Human Services. These long-term offenders could face civil fines and lose access to Medicare and other federal health problems.

It is estimated that at least $6 billion per year in improper payments are made under Medicare’s physician fee schedule, but some believe that estimate could be low. In most cases, the problem arises when doctors bill for items and services that are not considered medically necessary.

Levinson stated that investigators should focus on doctors with consistently high Medicare billings. He stated there are about 300 doctors that receive upwards of $3 million per year in Medicare payments and about a third of these are being questioned about their billing practices. Though high payments do not always indicate a problem with fraud or improper payments, officials believe this is a good place to begin their investigation.

Critics of the plans to investigate believe it is an attempt by the administration to exclude doctors from federal health care programs. Some are concerned that services that might appear medically unnecessary might actually mean a patient’s condition was not properly documented and the loss of a treatment could be detrimental to his or her health.

Release of Data

There is also debate over how helpful or hurtful it might be to release federal data concerning Medicare payments to individual doctors. The administration eliminated a policy that broadly prohibited this data release and stated they might release the information because of FOIA requests. Data will likely be evaluated and released on a case by case basis.

Those in favor of releasing the data believe it to be a good tool for consumers, researchers, and those looking for problems with Medicare billing. The data has been private since a 1979 court ruling stating that disclosure would violate the Privacy Act. Today, experts believe the need to view this data and recognize abuse is far more important than privacy concerns. However, some believe access to raw data could create a distorted picture of a situation and fail to demonstrate exactly how the funds are distributed, especially in the most expensive medical situations, such as oncology.

Medicare issues are as varied as the people enrolled in the system. It is complex and for many, quite confusing. If you suspect you are under investigation for Medicare fraud or you have been contacted by someone concerning a Medicare billing issues, call David Lindsey at 303.228.2270

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