>> The largest items in the federal budget are Social Security, Medicare, interest payments, and defense.
Last month I discovered on my wife's Medicare statement that she was being charged by two cardiologists for the same services. Has been that way for the last few years, I guess. It is a monthly billing for reading the telemetry from her sophisticated pacemaker. But somehow, both her cardiologist and the electrophysiologist who installed the specialized pacemaker, are being paid for the same service. Strange thing is she doesn't even routinely see one of them anymore. They had agreed between them that her regular cardiologist would be in charge of monitoring since she sees him routinely, but the one guy never dropped the fee.
So, the problem we have is that Medicare has been significantly overbilled for this service. It is nothing to us, Medicare takes care of it. But it is quite expensive, recurring monthly and technically is part of the "waste" in "waste, fraud and abuse". Most people wouldn't know the difference but I have worked with EOBs and things for decades so I see what is going on here. Totally unintentional waste, doesn't cost us anything, but definitely costs Medicare a lot.
How many patients do you think have similar situations? Every electrophysiologist referral comes from another cardiologist. Surely, this happens all the time. Every month. Not only with pacemakers. For a while I was getting a call from a NP at my knee specialist's office, asking questions "for the doctor", and she would ask about a dozen questions; the first couple of times I was okay with it but then I realized they were billing my Medicare account every time she called, and the questions weren't relevant to my treatment, so I just told her that was enough. Most of the patients probably didn't pick up on that. This was, as it turned out, an outside service provider who simply made the useless phone calls, provided the useless data back to my doctor, and charged Medicare for it. All totally legal make work.
My point is this is a massive waste category, just like the $216 million/year rental building in Pecos TX (undoubtedly, the largest single business operation in Pecos County.)
At any given time there are around 2 million of these devices in use in the US. The vast majority are undoubtedly covered by Medicare. And in cities, there are usually two more specialists involved in the installation and care of a pacemaker that receives telemetry. Yet, Medicare's IT systems don't pick this up. Typical failure. It is funny you tend only to see these problems with Medicare.
There is plenty of waste, fraud and abuse in Medicare to substantially reduce the cost of the Medicare system. |
