By HANS DUVEFELT
Almost every day I catch a suspicious fax needing my signature. Often it is an out of state vendor who wants my permission to provide a back brace for a diabetic patient, a continuous blood glucose monitor for a non-diabetic or a compounded (custom made) ointment of some sort that makes no sense from what I know of that patient’s history.
Often, I get a fax appearing to be from Walgreens, just asking me to sign and certify that so-and-so is under my care. Those faxes have Walgreen’s logo, my patient’s correct address and my own DEA and NPI numbers already printed. The problem is that 90% of my patients don’t use Walgreens 20 miles north or south of my clinic, but the local Rexall pharmacy. Once, I called the phone number on the fax and it just rang and rang.
I am convinced that his is just an illicit way to collect physician signatures, so the scammers won’t even have to get my signature on one form at a time. This way it’s like they’ve got their own rubber stamp to use again and again.
I suspect these scams are successful often enough to be quite profitable. I know this because I sometimes sign these forms almost automatically before I catch myself and toss them in the shred box under my desk.
One of the many dirty little secrets in medicine is that doctors get so many papers to sign that there is actually no way we could read them all before scribbling our signature if we still want to see patients, meet clinic revenue projections and match our own productivity quotas.
I used to joke that the only kind of paper in my clinic I didn’t have to sign was the toilet paper. In spite of our computers, we get more papers than ever before to sign. This is probably because everybody else, like the home health agencies, use their computers to generate more and more pages that require our signature.
The really disturbing thing about these scams is that these vendors are billing Medicare for things harried or otherwise inattentive doctors unwittingly “order”. The fact that they can bill Medicare means that they are somehow credentialed to do so.
It must therefore be way too easy to qualify for a place at the Medicare money trough.
Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.
Peter / Pedro, — Fraud is more than just a cost of doing business for Medicare and Medicaid mainly because they pay bills too quickly and don’t spend enough on data analytics to identify suspicious claims before they’re paid. I’m pretty sure that private insurers do a much better job in this area. It’s also worth noting that roughly 40% of Medicare beneficiaries now have private insurance in the form of a Medicare Advantage plan. These are especially popular among low income seniors because they don’t need a Medigap plan.
The real savings from Medicare for all would come from lower reimbursement rates and not lower administrative costs but hospitals consistently claim that they can’t make money if they had to accept Medicare rates from all comers even with no uncompensated care. Are you saying that they’re lying and, if so, what evidence do you have? If the hospitals are right, quite a few would close and many more would discontinue their least profitable service lines including OBGYN and mental health.
There was a documentary on TV last week aired by PBS titled “Critical Care: America vs. The World. It compared the American healthcare system with those in the UK, Switzerland, Australia and Canada. I would encourage you and others to take a look at it. It was pretty well balanced for the most part but I don’t buy the canard about attributing higher infant mortality and lower life expectancy in the U.S. to an inferior healthcare system. Higher infant mortality is due mainly to a greater incidence of poverty in this country. Lower life expectancy can be attributed also to a greater incidence of poverty plus the highest obesity rate in the world and quite a few more deaths here from murder, suicide, drug overdoses and auto accidents. None of those have much to do with the healthcare system. The obesity rate in the U.S. in the 1970’s was around 15% and now it’s approaching 40%. It has nothing to do with the healthcare system either.
Here is my summary of the conclusions from the PBS broadcast:
UK — The show portrayed a family with a child who has Down’s Syndrome and needs expensive and extensive healthcare services including aides who come to the home. It’s all provided free to the family by the NHS. Great. It also showed a woman apparently in her 70’s who needs a knee replacement. She’s in so much pain that she’s taking four opioid medications and has been on a waiting list for a year or more. If your condition is not life threatening, you are going to wait a long time. Ditto for seeing a specialist or getting expensive imaging like an MRI. Their National Institute for Health and Clinical Excellence (NICE) will refuse to pay for drugs they deem too expensive even if they would help the patients they’re indicated for. In the U.S., such an approach would be derided as death panels.
Switzerland — Lots of choice. Over 60 private insurance companies compete for business though the six biggest have most of the market. The population is less than NJ and the land area is comparable to CT. People can choose their deductible ranging from 300-2,500 CHF. The government has an extremely strict mandate to the point where it will garnish your wages to make you buy insurance if it has to. The typical middle class person pays 16% of income for health insurance. Lower income people get subsidies. The ACA caps the individual contribution at 9.5% of income above 250% of the FPL, I think, and the Biden administration wants to reduce that to 8.5%. In short, the Swiss system is very good but also very expensive for the average person in terms of the percentage of income spent for health insurance and many younger people would not buy health insurance if the mandate to make them buy it weren’t in place.
Australia — There is a public hospital system available to all but wait times can be lengthy for non-life threatening conditions like hip and knee replacements. There is a parallel network of private hospitals accessible to those who buy the private insurance that allows access to them. The insurance is comparatively expensive but, according to PBS, about half the population buys it. As I understand it, people who want private insurance must also pass medical underwriting.
Canada — Again there are lengthy wait times for non-life threatening conditions. Remember the court case that said access to a waiting list is not access to healthcare. Originally, the central government covered half the cost of providing healthcare and the provinces covered the other half. The central government gradually cut its contribution back and it’s now down to 15% with 85% left for the provinces to cover. Also, the Canadian system does not cover prescription drugs. PBS noted that the Canadian system covers about 70% of the cost of healthcare. People have to buy private insurance to cover the rest which many get through their employer as part of their compensation. Or they pay out of pocket.
At the end of the broadcast, the host interviewed two U.S. experts about how to improve our healthcare system. The two experts were Dr. Asish Jha, now at Brown University and formerly at Harvard and Princeton professor and health policy expert, Tsung-Mei-Cheng. She is also the wife of the late Uwe Reinhardt who was also a Princeton professor and health policy expert. Dr. Jha’s main recommendations were to expand Medicaid in all states and expand the ACA subsidies to all income levels rather than capping them at 400% of FPL income as was done under the ACA. I support both recommendations. He thought that could get us to 97%-98% coverage. Massachusetts is already there. The subject of whether or not to cover undocumented people was not addressed.
Fraud oversight is a fact of doing business (not just medical) anywhere in the world. Medicare-for-All would cut administrative costs and save Americans billions of dollars while doing away with surprise billings. It would level the playing field for people struggling to pay for medical care and free up cash for other sectors of the economy.
Barry, to give us the usual Republican baseless fear mongering instead of useful policy proposals shows desperation not solutions.
Imagine what it would be like if we had Medicare for all (single payer). Medicare brags about its low administrative costs but the AARP and others say fraud is a major problem for both Medicare and Medicaid. In fact, the more money Medicare loses to fraud, the more efficient it looks from an administrative cost standpoint!
Do you or other doctors you know have any thoughts about how to mitigate the problem you wrote about?