Jewish World Review Jan 21, 2005/ 11 Shevat 5765

Drs. Michael A. Glueck & Robert J. Cihak

The Medicine Men
JWR's Pundits
World Editorial
Cartoon Showcase

Mallard Fillmore

Michael Barone
Mona Charen
Linda Chavez
Ann Coulter
Greg Crosby
Larry Elder
Don Feder
Suzanne Fields
James Glassman
Paul Greenberg
Bob Greene
Betsy Hart
Nat Hentoff
David Horowitz
Marianne Jennings
Michael Kelly
Mort Kondracke
Ch. Krauthammer
Lawrence Kudlow
Dr. Laura
John Leo
Michelle Malkin
Jackie Mason
Chris Matthews
Michael Medved
MUGGER
Kathleen Parker
Wes Pruden
Sam Schulman
Amity Shlaes
Roger Simon
Tony Snow
Thomas Sowell
Cal Thomas
Jonathan S. Tobin
Ben Wattenberg
George Will
Bruce Williams
Walter Williams
Mort Zuckerman

Consumer Reports


Two-Faced Medicare Enforcement


http://www.NewsAndOpinion.com | Federal government prosecutors are sending doctors to prison for making mistakes in filing Medicare paperwork.

At the same time, Medicare customer service representatives are apparently not even reprimanded for a 96 percent error rate in answering questions about how to handle physician billings.

These representatives work at call centers operated by insurance carriers handling Medicare claims, and are tasked with providing clear and complete information about program billing requirements.

However, according to an audit conducted by the Government Accountability Office (GAO, formerly the General Accounting Office) from September 2003 to June 2004, call center reps answered only 4 percent of policy-oriented questions correctly and completely.

The call centers responded to more than 21 million inquiries in fiscal year 2003. Most of these calls were easily answered questions about the status of claims.

The huge error rate was in answering four specific policy questions about Medicare coverage and billing requirements. The questions and answers were cleared and approved by the Medicare administration before GAO employees made their calls. When they made the calls, the GAO agents identified themselves as working for the GAO and why they were calling with these questions. And the reps could use any and all of the reference materials provided them, essentially an open-book test.

This GAO report is further evidence, much lamented in this column, of the obstacles facing Medicare recipients and the physicians who serve them. The House Ways and Means Committee received the document "Call Centers Need to Improve Responses to Policy-Oriented Questions from Providers" last year. (See at GAO-04-669 http://www.gao.gov/new.items/d04669.pdf.)

Medicare paid more than $271 billion in claims in 2003. Since the program was created in 1965, its rules have swollen into more than 100,000 pages of statutes, regulations, policies and procedures that specify what the program will pay for, and under what circumstances.

No one can possibly master all the rules.

In spite of this, the law prescribes very strong penalties for "any person" defrauding Medicare. In practice, "any person" means "any doctor" and occasionally "a few insurance company executives." All the rest, including the workers at call centers, are held accountable to much lower standards and rarely suffer severe penalties, despite what the law says.

For example, the federal government allows some insurance company intermediaries for Medicare to waste up to 6 percent in incorrectly paid claims.

As the result of an audit instigated by whistle-blower Theresa Burr about BlueCross BlueShield of Florida, the federal government found mistakes costing taxpayers $74 million - but let the company get away with them. And this is just one intermediary out of hundreds.

What is the cause of such inequity before the law?

Although the blame-the-doctors trend started decades ago, the tendency gained traction with a popularized fear of rampant "fraud and abuse" of the Medicare program - a bogeyman based on unsubstantiated estimates and no data.

This myth stampeded Congress into passing severe penalties in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (HR 3103; Public Law No: 104-191), which now requires the federal government to spend more than $1 billion every year to root out Medicare fraud and abuse.

HIPAA is part of a trend to criminalize formerly civil disputes. This law creates so many potential "criminals" and gives government so much power that prosecutors have to pick and choose who to go after, due both to the huge pool of possibly guilty folks and their inability to put everybody in jail. Fair investigation, equal protection, and just prosecution are impossible in this environment.

Justice is obviously not served by applying varying standards of perfection to call center, insurance company and medical persons, in defiance of the law.

The Medicare program is fleecing a fortune out of the U.S. taxpayers. And it's impossible for anyone, including government consultants, to master its arcane intricacies. So let's quit pretending that throwing doctors into prison for billing errors will stem the flow of dollars into the Medicare black hole.

Donate to JWR


We believe justice would be better served by adopting a few simple measures, among others:

* Repeal criminal penalties for unintentional Medicare billing errors.

* Allow doctors a billing error rate short of perfection, maybe the same six percent allowed insurance companies.

* For true fraud, raise the threshold of damages before severe penalties can be levied. Currently, any alleged insurance billing error over $100 can result in a fraud charge leading to a five-year jail term.

* Maintain the government's burden of proof for severe penalties. Remember "innocent until proven guilty"?

* Allow jurors access to the facts and truth about everybody in the courtroom, including paid witnesses who stand to take a percentage of any fines the government collects if the accused is found guilty.

Overzealous HIPAA enforcement is making life more difficult for millions of Medicare recipients, destroying the lives of individual doctors and driving many others out of the program.

Many Medicare recipients are already having trouble finding doctors willing to accept risks of prosecution for the low payments allowed by the program. These severe HIPAA penalties are part of the problem, not part of the solution.

Editor's Note: Robert J. Cihak, M.D. wrote this week's column.




Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.

Up

01/14/05: The ABC's of Heart Healthy Dark Beer — For the games make it a dark cold one!
01/07/05/: Jury can fire liars for hire
12/17/04/: Life after Vioxx? — Pharmacetical competition good for patients and the industry
12/10/04: Fake drugs in your local pharmacy?
12/03/04: A Prescription for Taking Back the Right: The Right Rx
11/25/04: New Weapons in the War on Pain Patients and Doctors
11/19/04: Wedding Psychosis: A new diagnosis is born
11/15/04: What's the right price for pharmaceutical drugs?
11/05/04: Berry Healthy: Health Benefits from Antioxidant-Rich Foods
10/29/04: New Scientific Evidence Refutes Existence of Shaken Baby Syndrome
10/25/04: Fact-checking KerryCare
10/05/04: That old-time rare burger: Healthy or not?
09/24/04: Death is not a final diagnosis — Murder rates in US cities comparable to Iraq!
09/10/04: Mercury linked to autism
09/07/04: Sad child disease: Speaking out so that they can speak
08/20/04: Household Olympics: Losing and gaining points
07/30/04: Still Seeking Justice for Dr. Sell
07/26/04: Medicine, genes, sports and longevity
07/16/04: Biotech foods foolishly feared by Franken-Folk
07/09/04: The Runaway Trial Lawyer
07/02/04: Physicians not treating trial lawyers: A shootout at OK Coral and Courthouse?
06/25/04: Dosage makes the poison in 400-year-old mercury murder
06/11/04: Canada's health system dream turns to nightmare
06/04/04: It's A Medical Life — I Remember Yesterday
05/28/04: Back to the Future: Patient Pays Directly for Medical Care
05/21/04: Sue Your Boss Month
05/14/04: Death from painful medical myths
05/07/04: Fear in the Medical Garden of Eden
04/30/04: DDT vs. Death by Malaria
04/23/04: In pain do we part!
04/16/04: Free — or not free — to treat pain
04/09/04: Wrong Military Diagnoses & Treatments
04/02/04: Radiation monster slain
03/19/04: What Do — and Don't — Bush and Kerry Plan to do to Your Health Choices
03/15/04: Dear Rush: We Feel Your Pain, So Now Feel the Pain of Others
03/05/04: Fraudulent use of fraud laws — by government
02/27/04: Population growth, birth control and increased terrorism?
02/20/04: Doctors fighting against doctors, at the behest of the government and lawyers
02/13/04: Legal Cancer in the White House?
02/06/04: Feds Harass Doctors. Who's Next?
01/30/04: Women, the Military and Medical Misconceptions
01/23/04: Welfare for the Wealthy
01/19/04: New diagnoses and strategies create both short and long term problems for medicine and the military
01/09/04: A new plastic phobia?
01/02/04: Baseball Good Medicine?: International Forkball and Split Finger Rotating Our Way Soon
12/26/03: Medicare Bankrupt: A Possible Palliative 12/19/03: Crossing Fruit Street: Some Movies Like "Stuck on You" Cross the Medical Line
12/12/03: Silver Lining in the Medicare Clouds?
12/05/03: Medicare mop up
12/01/03: The Dirty Radioactive Bomb: Rational Response or Fear Itself?
11/24/03: The Caduceus Conspiracy: How the People Lost Medicine and How We Can Take It Back
11/14/03: Mosquitoes kill us; DDT doesn't
11/07/03: Avoiding the Schiavo Scenario: Readers Speak Out With Life-and-Death Comments
10/31/03: The Terri Schindler-Schiavo Case: Speaking out for those who can't
10/24/03: Want health service — go on a diet?
10/15/03: The War on Legal Painkillers: Sen. Kerry owes an apology to the more than 48 million Americans who suffer chronic pain
10/13/03: Medicare defrauds itself
09/19/03: Politics prevents women from learning about abortion/breast cancer risks
09/12/03: Medical mischief
09/05/03: Unholy medicine
08/29/03: The California Tea Party and West Coast Determinism; Voter anger coming your way soon
08/18/03: The outlaw prosecutors: A Justice and Civil Liberties Issue
08/08/03: "Toxic Teeth?"
07/25/03: Resuscitating the Constitution; CPR American Style
07/25/03: Drug reimportation: Bill translates to goodnight, patients
07/11/03: Costly Medicare Changes, Without Real Reform
07/04/03: The Painful DEA II: War on legal drugs ensnares too many doctors and not enough dealers
06/20/03: The Medicare Mess: Will President Bush call Congress' Bluff?
06/13/03: Diagnosis: School Insanity: A suit for sanity and school discipline
06/05/03: Soaring Medical Costs: Rational ignorance or rational enlightenment?
05/30/03: A Tale of Two Admirable Women: Jessica and Annika
05/23/03: Latest medical innovation: Cash
05/09/03: We feel your pain; Physicians have it too no thanks to the DEA
05/02/03: Medical Quarterbacking
04/25/03: CNN the "Conscience-Not Network"
04/21/03: Medical Miranda?
04/11/03: Are childhood vaccines shots in the dark?
04/09/03: The PETA Principle -- The lambshank Redemption
03/28/03: American conscience?
03/21/03: West Wimps or Wings: Treatment for Hollywood Hypocrisy
03/13/03: Worldwide schmaltz shortage looms --- all because of a featherless chicken
03/06/03: Legal metastases are killing us
02/28/03: Outside the Jury Box: Seeking Justice rather than a Lottery in Medical Liability
02/21/03: Workforce temperature rising; employer TLC in demand
02/14/03: Malpractice Insurance: They Reap What They Sue
02/12/03: Hawk, Dove or Groundhog: Diagnosis Critical List; Prognosis Uncertain
02/07/03: How about tax cuts for the "rich" and "poor"?
01/31/03: AIDS Bug Chasers
01/24/03: Libertarian moment or movement?
01/17/03: It's not just 'sue the docs' anymore
01/03/03: A pox on the critics; diagnosis sour grapes
01/03/03: If protesting is good for your health; then at least let's root for the home team
12/20/02: Obesidemic (obesity epidemic) or not?
12/20/02: Time for voluntary informed smallpox vaccinations
12/13/02: The real reason the state opposes homeschooling?
12/06/02: Conscience of a former conservative: Portrait of a political metamorphosis
11/27/02: Thanksgiving dinner hazard?
11/22/02: Time to think outside the box and inside the nucleus
11/15/02: The military should be protected from abusive environmental laws in times of war
11/11/02: Does Kyoto Treaty pose more harm than global warming?
10/31/02: Deep thoughts on Baseball, the World Series and Life: How about them Anaheim Angels?
10/23/02: "Pediatric rule" guinea pigs
10/23/02: Once the World Series ends, we need to create a Donnie Moore Day of Remembrance: Sports and mental health
10/18/02: Congress to senior patients: Do as we say not as we do for ourselves
10/11/02: Using pollution "scare labeling" to political advantage
10/04/02: The Great Asbestos Heist: Did Litigation and Junk Medical Science Helped Bring Down the World Trade Center?
09/27/02: The imminent rise of civic feminism: A far healthier national alternative in war and peace
09/20/02: A Ray A Day" to replace the daily apple?
09/13/02: Beware of celebrities hawking drugs
09/06/02: Avoid 9/11 overdose: Give blood to begin "September of Service," SOS
08/28/02: From Doubleday to strikeday: Baseball's collective anxiety attack
08/23/02: Should she or shouldn't she?: An alternative view on treating menopause with HRT
08/16/02: Cooking up defenses against germ warfare
08/02/02: Medicine, crime and canines
07/26/02: Lies, pathologic lies and the Palestinians
07/19/02: Medicare Drug Follies as in "now you see it, now you don't"
07/12/02: Anti-Profiling: A New Medically False Belief System
07/08/02: Don't procrastinate, vaccinate!
06/28/02: The scientific advances on the safe and effective deployment of DDT are being ignored, or denied. Why?
06/21/02: Sex and the system: In seeking healthcare men are different from women
06/14/02: The FDA, drug companies and life-saving drugs: Who's the fox and who's the hen now?
06/07/02: Medical Privacy Lost: A hippo on the healthcare back!
05/24/02: To clean up America's game: A (soggy) ground rule
05/10/02: Free speech is good medicine
05/03/02: Medicine's Vietnam
04/26/02: Attack on alternative medicine could lead to alternative lawsuits
04/12/02: Insure the 'crazies'?
04/09/02: No Time for Litmus Tests: In War We Need a Surgeon General and NIH, CDC, and FDA Directors
04/02/02: The scoop on soot: A dirty rotten shame?
03/22/02: Too many beautiful minds to waste: The first annual Caduceus Movie
03/15/02: Terror and transformation: Defense essential for health & state of mind
03/08/02: Diagnosis: Delusional
03/06/02: The great matzah famine
03/01/02: Is new Hippocratic Oath hypocritical?
02/15/02: Why the recent moaning about cloning?
02/08/02: Searching for Dr. Strangelove
01/15/02: Score one for the value of human life
01/04/02: Medical-legal-financial wake-up call
12/28/01: Who's afraid of a 'dirty bomb'?
12/21/01: End of medicine?
12/14/01: More heroes: Docs deserve a little credit after 9/11
11/16/01: Do we need 'Super Smallpox Saturdays'?
11/09/01: Why the post-9-11 health care debate will never be the same
11/01/01: Common sense good for our mental health
10/26/01: Your right to medical privacy --- even in terror time
10/12/01: Failed immigration policy ultimately bad for nation's mental health: Enemy within leads to epidemic of jumpy nerves
09/28/01: Can legal leopards change their spots: A treat instead of a trick
09/21/01: Civil defense again a civic duty
08/30/01: Shut down this government CAFE
08/23/01: School Bells or Jail Cells?
08/15/01: Time to take coaches to the woodshed
08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy

© 2005