Op/Ed: Fraud and Anonymity: The Perils of Medical Care Bureaucracy

AddThis Social Bookmark Button

As we march into the 2020 Election season, the high cost of medical care is on the lips of every politician and draining the pocketbooks of most Americans, and this hot button topic will see microscopic examination.

After creating the Medicare/Medicaid monster, the government's expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance. Piling on more laws, regulations, and agencies is not the answer.


Beltway Insider: Trump, Pelosi, Impeachment, Ukraine, China, Whitey Bulger, Sanders/Omar/Student Loan, Diahann Carroll

Anonymity, complexity, and opacity invite shady behavior. Individuals, companies, and patients who defraud the massive federal "health system" would never dream of lifting money from their patients' wallets or stealing from their doctors' cash drawer.

The government's track record does not bode well for imposing more bureaucracy to remedy a problem created by the layers of third-party payer bureaucracy. Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds.

Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare's total payments. By contrast the typical private business loses 5 percent of its revenues to fraud. Unfortunately, since its inception in March 2007, the Medicare Strike Force has recouped less than $2 billion per year in misappropriated funds.

Medicare's $16.7 billion per year hospice program is fertile ground for the unscrupulous. Hospices are paid a fixed daily sum for each patient enrolled "regardless of the services provided." One amoral scheme recruit's patients who unknowingly forgo curative treatment options by joining hospice.


Op/Ed: Don’t Buy What They Are Selling

A recent Office of Inspector General (OIG) report revealed that in 2012 hospices billed Medicare more than $250 million for services to patients in long-term care or assisted-living residences who did not require hospice care, costing four times more than the appropriate level of care. Even worse, the OIG found that the quality of care suffered in 31 percent of programs. The bureaucratic morass allows the perpetrators to pocket the fixed fee and skimp on the services.

 Further, the government cannot keep track of its program dollars. According to another OIG audit, in 2009, Medicare Prescription Drug program paid $33.6 million and hospice patients paid $3.8 million for medications that should have been included in the hospice daily fee.

Even after discovering the snafu, the problem got exponentially worse. In 2016 the government paid $160.8 million for drugs that hospice organizations should have paid for from its fixed daily fee. Our tax dollars paid for the drugs twice.

Physicians know what patients want and are acting on it. Free from the restraints of government "healthcare" programs, the physician-led, price-transparent, direct-pay Surgery Center of Oklahoma performs some surgeries for less than the co-pays of some insurance policies. Direct Primary Care physicians provide 24/7 access and basic labs for as little as $50 per month with at-cost medications and low-priced x-rays.


Op/Ed: Russia, Racists, and Ridiculousness

The corporate private sector has learned a thing or two from innovative physicians. Care Accelerator is Sam's Club's version of "affordable [medical care] options with transparent pricing." To offer relief from high out-of-pocket costs, $50 (individual) to $240 per year (families) buys access to lab screening for diabetes and heart disease, free generic drugs, telehealth, and up to a 30 percent discount on vision, dental, and other ancillary services. Additionally, Walmart is training its own employees for jobs in the health sector and ideally to staff Walmart's own medical services. For their employees, Apple has "health care built around you" with its AC Wellness that offers office and home visits; Amazon launched its Amazon Care telemedicine services.

Given the outrageous price of drugs—largely due to the pharmacy benefit manager middlemen—Good Rx discount coupons are just what the doctor ordered. Good Rx is free to the consumer and makes money from advertisements on the website and referral fees.

One typical victory is a Medicare patient whose neurologist prescribed a drug for his Parkinson's disease symptoms. The government demanded testing that could not be done because of the patients debilitated condition. Despite a sympathetic ear and supporting research, the government arbiter could only parrot the party line: because the drug was not on the "list," it was not covered by Medicare.


A Different Kind of Force – Policing Mental Illness

In a fortunate twist of fate, with a Good Rx coupon the patient paid $34 per month cash instead of the drug's $1,100 per month price with 20 percent patient co-pay that would have been charged through the Medicare Prescription Drug program.

Congress claims it plans a full-frontal attack on the high cost of medical care (with the same results as the war on poverty and drugs?). Frankly, we are better off with Congress engrossed in its impeachment clown show and keeping its nose out of our medical business.

  

 

 

Bio: Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School.  Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard's Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law.  She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. She lives in Oakland, Ca.

Haute Tease

  • Assassin’s Creed Review – Intriguing and Surprisingly Good

    AddThis Social Bookmark Button

    Assassin's Creed, from 20th Century Fox and Regency Enterprises, brings to the screen an epic battle between history and science, good and evil, free will over conditioned responses, and even nurture verses nature in a quest that crosses time.

     
  • OCEANA Hosts Celebrity Studded Benefit

    AddThis Social Bookmark Button

    OCEANA, the international oceanic conservation organization, recently launched the opening of its New York office with a celebrity packed benefit on posh Manhattan's Upper East Side.

     
  • CURE SPA MALIBU Review - A Blissful Indulgence

    AddThis Social Bookmark Button

    CURE MED SPA Malibu, a health and wellness center, offering a variety of treatments guaranteed to calm body, mind and soul recently provided an afternoon of treatments at its newest facilities overlooking the incredible Pacific Ocean.

     
  • Beltway Insider: Trump Recaps Asian Trip; Tax Bill; Puerto Rico; Morocco Stampede; UAE MARS City; Keystone Leak; Black Friday

    AddThis Social Bookmark Button

    Today, two months after Hurricane Maria decimated Puerto Rico leaving 95% of the inhabitants without electricity, 88% without clean water, another 70,000 in danger from a breech in the Guajataca Dam and now, the devastation remains with little progress.

     
  • The Neon Demon Review – Chilling Perfection

    AddThis Social Bookmark Button

    The Neon Demon, from Broadgreen Pictures and Amazon Studios, present a chilling tale, in modern film noir, of life inside creative pursuit circles, where beauty is the only currency and career is on life support before twenty.

     
  • A Halloween surprise FRANKENWEENIE, from WALT DISNEY and Tim Burton, is all treat!

    AddThis Social Bookmark Button

    FRANKENWEENIE, from the genius of Director Tim Burton, presents a story that will awaken the dead as it tells the tale of a promising, scientist filmmaker, his dog and a love that wouldn’t die.

     
  • Kim Wall Murder: Peter Madsen - Mad Scientist or King of the Fetish

    AddThis Social Bookmark Button

    Denmark's most sensational murder trial has yet to begin and the world media is ramping up its coverage on Peter Madsen, the Danish inventor who is currently held in the horrific dismemberment and murder of Swedish journalist Kim Wall.

     
  • Weddings & Celebrations: Hall and Walt Wines, of Napa Valley, Offer Personalized Vino Packages

    AddThis Social Bookmark Button

    The luxury vineyards of Hall and Walt Wines in Napa Valley are now offering customized winery packages for off-site weddings and celebrations bringing its delicious, world renowned wine, to your table complimenting that very special day.

     
  • Oliver Stone’s South of the Border: Sizzling Hot

    AddThis Social Bookmark Button

    Oliver Stone’s newest film South of the Border, “A Political Road Movie” fills the back seat of the old beat up opinion and travels, through the seven countries of South America, serving up more heat than the media can handle.

     
  • Netflix Scores Big With Seven Creative Arts Emmy® Awards

    AddThis Social Bookmark Button

    LOS ANGELES, CA – August 16, 2014 – Netflix connects with audiences and Hollywood alike, garnering four Creative Arts Emmy® Awards for its lauded series "Orange is the New Black" and "House of Cards," and three wins for its acclaimed documentary, "The Square."

     
  • Virtual Revolution Review – Haunting Tale of the Connected Future

    AddThis Social Bookmark Button

    Virtual Revolution, from Wild Eye Releasing, brings to the screen a visually graphic and shocking world of 2047 where society is divided into two groups those who live for their Virtual Reality existence, the corporations in control the gamers.

     
  • Beltway Insider: Zimmerman Acquitted; Malala Address UN; House Paves Way to Cut Food Stamps; DHS Napolitano Resigns

    AddThis Social Bookmark Button

    President Obama in a statement addressed the nation and called for calm in the wake of the verdict vindicating George Zimmerman of murdering Trayvon Martin and asked Americans to reflect and honor Martin’s memory.  

     
  • Arizona Family Laid to Rest; Tenth Victim Found

    AddThis Social Bookmark Button

    Ten white coffins lined the front of St. Patrick’s church in Scottsdale, Arizona, as three generations of Raya family were laid to rest yesterday, the victims of the Payson flash flood that killed them instantly during a birthday celebration.

     
  • Griffin’s Kiosk – A Secure Display Mount for iPad Use in Retail and Commercial Setting

    AddThis Social Bookmark Button

    Griffin Technology, one of the world’s foremost creators of innovations for everyday life, has announced the immediate availability of Kiosk, a secure display mount for all iPad models.

     
  • Beltway Insider: Trump/Mueller, Testimony Takeaways, Baltimore, Border Wall Boost, Brits PM, Royal Navy

    AddThis Social Bookmark Button

    President Donald Trump continued his divisive rhetoric as he celebrated what he interpreted as a complete vindication derived from the testimony of former Special Counsel Robert S. Mueller III, which others interpreted as filled with evidence of treason.