Medicare overbilling rampant among crooked docs

Medicare is one of the individual biggest line-items in the nationwide spending budget, with hundreds of millions being allocated to medical care for our country's senior citizens. However, a recently released study suggests that doctors are engaging in Medicare overbilling, because of some taking advantage of deep federal pockets.

An excessive amount of overbilling

According to SmartMoney magazine, a recent study that appeared in the “Journal of General Internal Medicine,” shows that the average out-of-pocket expenses in the last five years in the life of a Medicare recipient might be as high as $100,000. That amounts to up to one-quarter of all of their assets. Not income, assets. That includes selling things like cars, homes and large amounts of possession.

Paying for the medical care, specifically at the end of life when it gets really expensive, can cost enormous payday loans or put someone through bankruptcy before death. NBC News estimates that the majority of the costs that are being spent are on overbilling Medicare recipients.

Reason behind overbilling

The report, “Cracking The Codes,” by the Center for Public Integrity, found numerous doctors are engaging in Medicare overbilling, by selecting more costly billing codes than might otherwise be necessary for Medicare sufferers. It is estimated that at least $11 billion has been overpaid in the past decade.

The Washington Post points out that 370 million claim codes are received yearly by Medicare. About 5 percent of them, or 362 million claims from 2001 to 2010, were observed for the study.

What the researchers noticed was that the most costly codes became more prevalent over time, as the two most costly codes amounted to 25 percent of claims in 2001, increasing to 40 percent by 2010.

Roughly half of the posted codes were from physicians, the rest being from hospitals, nursing homes and so forth. More costly codes often involve more face time with sufferers. The variety of physicians who billed at least half their Medicare sufferers at the top two codes doubled between 2001 and 2008. Some showed restraint, as the number of physicians who stopped billing the top two codes reduced 63 percent in that same time frame.

Guilty hospitals

About 45 percent of all visits to hospitals in 2008 were reported as one of the two most expensive codes as well. In that year, about 60 percent of ER visits by Medicare patients qualified for those codes, according to 10 percent of the nation’s hospitals.

There are more advanced technologies than ever and people are living longer than they ever have before. There has been increased care, which is just one explanation for the extra billing. Still, from 2001 to 2010, the sufferers did not get any sicker.

It costs more money to review Medicare fraud than it does just to let it take place, and that is why medical overbilling is occurring and likely will not stop. It costs $30 to $55 to review the cases and only $43 on average every time the overbilling occurs. The government is already spending $500 billion of the countrywide budget on Medicare, which is one of the largest countrywide expenses.


Washington Post

Smart Money