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Tuesday, December 2, 2014

Pigs at the Trough

In August 2014, President Obama declared war on Medicare fraud. This seemed like a laudable goal, since fraud and unsystematic overcharging account for about $60 billion or 10% of Medicare’s annual costs. Medicare is the best health insurance program in America and should be extended to every American citizen; however, it is threatened by expensive fraud.

Let me be clear: the fraud of which I speak is not committed by the patients or customers receiving healthcare services or products, but rather by unscrupulous doctors, pharmacists, medical device retailers, and other healthcare providers. The solution is not to throw the baby out with the bathwater and end Medicare as some on the political right wrongly argue, but rather to expand the program to cover all citizens while eliminating fraud.

At first glance, it would seem the government had taken the proper initial steps in this endeavor. Medicare sends out a monthly Summary Notice that lists all the claims healthcare providers have submitted to it on a patient’s behalf and asks the patient to report to Medicare any doctor, provider, or service listed that the patient does not recognize. Billing Medicare for services a patient did not receive is a major source of Medicare fraud, so we can all help the government save taxpayer money – not by eliminating an essential program — but by reporting fraud. The government makes this easy by including the following on its Medicare Summary Notice:

“How to Report Fraud: if you think a provider or business is involved in fraud, call us at 1-800-MEDICARE (1-800-633-4227). Some examples of fraud include… Billing you for Medicare services you didn’t get.

That seems rather straightforward. So when a friend showed me three identical instances of an unrecognized healthcare provider having charged Medicare on his behalf, I agreed to dial the number and report the suspected fraud. No good deed goes unpunished. Apparently, Medicare does not have a dedicated line to report fraud. All fraud calls go into the main Medicare number, where everything from information to benefit calls are waiting on hold in the queue. Of course, there is no human to answer the phone. Callers receive an option of: “Press 1, Press 2, Press 3” ad infinitum. To make matters worse, there is no option to push to report fraud. But you can stay on hold for the operator… Which I did, until my phone battery died.

I called back later. Again, I waited on hold, simply to reach a live operator so she could tell me to whom it might be I would need to speak. I had plenty of time on hold to ponder the irony of waiting to speak to someone who was not the person I wish to speak to. After 10 minutes, my call was disconnected.

I called back three more times. Finally, I reached an operator and told her the purpose of my call: I was calling Medicare to report suspected fraud, as I’d been instructed to on the Medicare Summary Notice. She told me the number I had dialed – the one clearly printed on the form they had sent instructing people to dial to report suspected fraud – was not the right number to dial. I pointed out it was the number they had printed on their own form under the words “How to Report Fraud” but that did not impress her.

“They put the Medicare number on everything,” she said. “You need to call a different number.”

I asked her to transfer me. She said she couldn’t, and that I’d have to call the number directly. She gave me the number – 1-800-447-8477 – and I dialed it.

“U. S. Department of Health and Human Services, Office of the Inspector General,” a pleasant recorded voice greeted me. It proceeded to offer me multiple “Press 1, Press 2, Press 3” options for everything from the agricultural department to the Affordable Care Act. But there was no option for Medicare fraud, and even more disturbingly, there was no option to speak to a live human being… Not even the option to wait on terminal hold.

Imagine witnessing a crime and not being able to phone the police. Crime would be even more rampant than it is today. I now see the appeal of white-collar crime. Here is a $600 billion piggy bank and no one cares who is siphoning from the trough. I’m surprised only 10% is stolen through fraudulent charges each year.

So, President Obama, here’s a way to save $60 billion a year in your new war on Medicare fraud. Spend $50 a month to set up a dedicated phone line for people to report fraud. If you really want to go whole hog on guarding the trough, hire a few of the nearly 6% unemployed people in the country to answer the phones. If you insist on using automated “Press 1, Press 2, Press 3” recordings, then at least have one option for reporting fraud. Make sure the phone number that you tell people to call to report fraud actually leads to someone who handles that. This is called common sense, a new concept I would like to introduce to the government. Trust me, it will pay for itself. If you have any questions, give me a call at 1-800-633-4227.

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