Fraud Making Medicare Situation Worse

We all keep hearing about the problems with the Medicare system including mistakes and underbilling, overbilling and the like.  We also hear about fraudulent claims, but things are a lot worse than we have been aware of, and it is costing billions of dollars that could be going toward benefits rather than cuts.  The government has been authorizing reimbursements to fraudulent companies for wheelchairs and other equipment, and these reimbursements have cost over a billion dollars.  Most of these payments have been made to fake doctors and fake medical supply companies. In fact, the Government Accountability Office (GAO) has been investigating the Centers for Medicare Services (CMS) over the past year and found that CMS had granted billing privileges to two phony companies based in Maryland and Virginia who were supposed to be suppliers of equipment for Medicare recipients, but had no supplies whatsoever to provide to these individuals.   In setting up this investigation, the GAO provided CMS with false and sketchy information, and CMS still provided them with the ability to bill for services.  This put the fake companies into a situation where not only could they bill for millions of dollars, but they could have also gotten a doctors’ identification code fraudulently and started submitting claims, costing CMS even more money in payments.  This “sting” by the GAO proves that there are issues with the enrollment process for Medicare suppliers and that there need to be changes so that fraudulent suppliers don’t take advantage of these issues and loopholes.  As a result, the GAO has recently made some changes in enrollment procedures including the requirement that suppliers must be certified and meet other quality standards before they are allowed to do any billing. In addition, some other changes include making it mandatory for suppliers to keep all paperwork from doctors, limiting the use of pagers and cell phones as primary contact numbers for suppliers, and setting up new competitive bidding procedures for suppliers of medical equipment.  CMS has been promising since 2005 that they would eliminate much of the fraud in the system, especially in approving fraudulent suppliers.  This latest study by the GAO shows that there are still too many problems costing the system, the taxpayers and Medicare recipients too much, with the potential to cost them even more.  Had there been real companies behind this sting, rather than fake companies, it could have cost many more millions of dollars. With Medicare benefits in jeopardy of continuing to be cut, it is time to make sure that CMS is doing its job rather than giving money that is already too scarce away.  Perhaps if that happened, cuts would not be necessary and Medicare recipients could receive the benefits that they truly need.

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Two Sides of E-Prescriptions

In 2006 Medicare made it mandatory for all pharmacies accepting Medicare as payment for prescriptions become ready for E-Prescriptions.  Two years later, currently in 2008, Medicare is offering doctors who use E-Prescriptions when prescribing prescription medications, a bonus for five years, beginning in 2009.

Because there have been so many errors when it comes to writing and reading prescriptions, and too many of these errors have been fatal, Medicare is doing all it can to get physicians and their offices on board with writing E-Prescriptions, including offering the financial incentive. 

This creates extra money for the doctors, less problems for the pharmacies and more safety for the patients.  That is one side of the situation.

The other side of the situation is that in order for the doctors to be able to write E-Prescriptions, it will involve them buying software and other programs, which will involve them spending extra money.

Though the doctors will be receiving a 2% bonus during the first two years, it is estimated that the cost of the system alone – up front and in advance of bringing in any money – is anywhere from $2,000 to $4,000, which is a good sized investment in an already thinly-stretched medical practice whose Medicare reimbursements usually do not even cover the costs of services to the patients these doctors serve who are using Medicare as payment. 

We are not talking about huge, upscale, overpriced practices here.  We are talking about practices where doctors, nurses, physician’s assistants and others work hard and try to stretch every Medicare dollar in an effort to continue serving as many patients on Medicare as possible.  To a practice such as this, even $1,000 can be a tremendous amount of money.  Even though the doctors will receive the bonus, it may take time for them to recoup the money.

If there is a way for the doctors to sign on to the E-Prescription system and overcome the barrier of the initial cost, it will be a win-win situation for all, especially their patients.  It may take some time for everything to fall into place, however, if even half of the doctors who take Medicare as payment work with E-Prescriptions, many patients lives will be safer because of it.

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