Letter to the Editor

I've enjoyed Milt Zall's Bureaucratus column for years. The "Medicare rip-offs" column in the March 12 Federal Computer Week hit close to home.

My 83-year-old mother still has a very sharp mind. She cross checks all the bills and statements she receives. She is on Medicare but also pays to continue Blue Cross coverage as a type of gap coverage insurance (my late father was a postal employee). She tries to report all the billing errors she catches, including the doctors who claimed to have visited her during her last hospitalization. She was billed for consultations of doctors who did little more than walk by. In some cases they never even saw my mother. Let's not even raise the issue of whether any of the "services" were actually needed.

But an even bigger issue involves medical equipment. I certainly can understand that the temporary use of equipment has to be billed at a "reasonable" recharge rate. Wear and tear is high on some equipment. But for many chronic conditions, the patient will probably have the device for an extended period of time (for example, oxygen machines or nebulizers). In those cases, the cost of the equipment is usually paid off in less than six months, but the Medicare billing continues monthly and indefinitely.

Given that the original manufacturer or reseller writes this equipment off in 24 months, why does Medicare continue to pay premium rentals indefinitely? In some cases as little as three to four months of Medicare payments equal the purchase price of the equipment. Many of these devices are not available for sale to patients, even those with prescriptions. And like most equipment in the rental pool, it tends to be older models that are less user-friendly.

Similar tradeoffs occur between services and equipment. Medicare appears to have a much easier time approving a wheelchair than it would the physical therapy that would restore mobility. And of course let's not get into the absurdity of federal, insurance company, clinic and medical practice forms, most of which capture redundant information.

Also, given the patterns of prescribing numerous medications for seniors, isn't it a little odd that most of the forms that ask for your current medications only give you room to mention one or two drugs? And we're surprised that physicians don't catch drug interactions.

There's almost no end of items to mention, but I'll stop now. Thanks for being our eyes and ears for the many outrages that never make it the general media.

Name withheld upon request
University of Michigan

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