- By Milt x_Zall
- Mar 11, 2001
As a federal employee, why should you care about Medicare scams? Because you're paying for it. Feds in the Federal Employees Retirement System pay 1.45 percent of their salary for Medicare benefits that the government promises you when you reach 65.Experts warn that, for different reasons, Medicare will go broke in about years because it is spending more than it takes in. What no one talks about, however, is the fact that Medicare pays doctors who claim to have provided benefits to patients without requiring them to prove it.
It's true that Medicare has the right to audit a doctor's records to verify that benefit payments are supported by necessary documentation. However,as a practical matter, Medicare only audits doctors who are receiving an unusually high level of payments compared with what the plan is paying other doctors who provide similar services.
A friend of mine on Medicare told me about how some doctors pad their Medicare claims. For instance, my friend went to a podiatrist to have his nails trimmed. The podiatrist assured him that there was no problem getting the visit covered, although my friend expected to pay out of his own pocket.To my friend's surprise, Medicare paid the podiatrist for his services.The podiatrist claimed that he treated an infected wound on my friend's leg! In most instances, everyone keeps quiet and this scam continues.
My friend also told me about a game his primary care physician plays.His doctor does not participate in Medicare, and by law, such physicians can charge 15 percent more than the Medicare allowance for their service.So the doctor claims that the visit was "extended," which allows him to charge Medicare more than he should. There is no evidence required of the doctor and, even if he is audited, his records will show that he treated a patient for an "extended visit."
In another example, some doctors will visit you in the hospital even if they have very little involvement in your case. But the doctor is not coming by to cheer you up. He is coming by to file a claim with Medicare.The doctor then makes an annotation on the patient's chart that he "consulted"the patient and bills Medicare.
The flaw in the way Medicare handles doctors' claims stems from the fact that doctors don't have to prove that they are entitled to the payment.If you or I want an insurance carrier to pay for something, we have to fill out a form and submit documentation. The insurer insists on evidence. But not Medicare. It takes a doctor's word.
As long as Medicare operates this way, it will always operate in the red. This practice must be thoroughly investigated and stopped. Otherwise,your payroll taxes are being wasted, and you may never get the Medicare benefits you're entitled to.
Zall is a retired federal employee who since 1987 has written the Bureaucratus column for Federal Computer Week. He can be reached at [email protected].