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« On The You-Tube Picket Line at Age 94 | Main | It's (Not) Your 401k »
November 29, 2007 |Permalink |Comments (2)
Perverse Incentives
I continue to believe that health care is a right, not a business.
Diane over at Cab Drollery: "A place for a tired old woman to try to figure things out so that the world makes a bit of sense." We find a bit more evidence of what happens when profits come before people.
At the end of September, I posted on how some private contractors for a Medicare audit had turned into bounty hunters eagerly savaging the bills of rehab hospitals providing services to Medicare beneficiaries. The audit was a trial run ordered by Congress and involved three states: California, Florida, and New York. In California, records show that the auditors routinely rejected bills (up to 90%) from those rehabilitation hospitals providing services to those who'd had total knee or total hip replacements. As a result, several of those hospitals have closed or are about to.
There is a rat here somewhere. Either these hospitals have been dragooning elders into un-needed and un-necessary rehabilitation on a massive and unprecedented scale, turning entire hospitals into giant engines of fraud...
Or the auditing company is being too aggressive and retroactively denying huge number of legitimate claims.
Which could it be?
Among the biggest concerns is that the congressionally created program relies on "recovery auditing" – auditors who are paid a percentage of the money they recoup from hospitals through claims denials."This contingency fee or bounty mechanism sets some incentives for these auditors to be overly aggressive and to make questionable decisions in their favor by denying claims," May said.
More on "recovery auditing" here.
But because of the California experience – in which rehabilitation hospitals have been forced to surrender tens of millions of dollars for past services deemed by auditors to be medically unnecessary – Democratic Rep. Lois Capps of Santa Barbara and Republican Rep. Devin Nunes of Visalia recently introduced legislation that would place the program on a one-year moratorium to investigate the problems. ...
One last bit of wisdom from the comments to the original post at Cab Drollery...
VizierVic says, "Bulls make money, bears make money, pigs get slaughtered."
Comments ( 2)
Medicare audits in hospitals are just a small piece of the "bounty hunting" rebater's pie. There is growing medicare fraud among doctors and facilities responsible for the subacute and long term care of our elders. The system is so large and unchecked that millions of dollars are paid out for nursing home visits by PCPs that never took place, PCPs referring pts to GI docs for g-tubes that are not necessary, or surgical procedures that add nothing to the health and well-being of the elder. One doctor in the Baltimore area recently lost his medical license because of gross medicare fraud and the neglect of the patients he allegedly cared for in multiple facilities. Unfortunately there are many more like him that will never be reported or found out because of things like HIPPA (families and guardians don't always have access to records to cross check)and retribution at the job.
The whole medicare system was raped by providers in past years; this has led to tighter governmental control and the farming out of auditing jobs like you mentioned in the above entry.
There are many individuals today receiving the benefits of medicare that the original authors did not even consider. Then the fraud that exists in helping people qualify for Medicare and SSI is amazing, in a horribly sickening way.
The hippocratic oath is only as good as the honorable doctors who practice it, and their numbers are shrinking.
The bottomline - our elders are often viewed and treated as "money makers" instead of the priceless treasures they are.
This is still the last big rackett out there for people to take advantage of, and the wonderful thing is we ALL are paying for it!