By Steve Keene / September 10, 2009 at 12:52 am
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fraud and abuse in Medicare. Hospitals and doctors must be alert to this. I once worked temporarily in hospital billing and was periodically called in. I filled in forms on a sort of cardstock for Medicaid. The same forms were handed to me, again and again. I have a good memory for details. I also did the coding. Sometimes a diagnosis made no sense, and I would ask the doctor, and a totally unrelated diagnosis would be given and then coded by me, but some diagnoses, such as cellulite as a sports injury were a little “unusual”. As doctors know Medicaid comes partially out of Medicare and partially out of State Funds. The case I cited was in TN, not in NC. This was a fully staffed department, and my presence to do that work was not relly needed. Another issue, which I experience regularly as a Medicare patient, multiple billing for the same office visit. If I state that I have already paid the charge (with proof), they answer: *yes, but we have applied that elsewhere*. The elsewhere was also already paid in full. It is a game of chicken, because ultimately an unneeded outflow of funds out of Medicare does not benefit doctors. I am certain that medical personnel can be alert to certain kinds of mistakes which are costly. I am for the healthcare reform, and have been actively promoting it on websites. I would also like to see total elimination of MMI (Medical Malpractice Insurance). It would be helpful if doctors and the AMA come up with procedures and suggestions to make this idea more logic to the larger public.If subsidies out of Medicare to Advantage programs are eliminated, supplemental insurance might be more palatable and logical to me. Finally, administrative reforms and computerization should be cost reducing. Friends @ the VA tell me that their procedures work very, very well. A model to investigate? Another idea, same friends @ VA have told me that not only patients, but whole families, are relocated sometimes for treatment. If crossover VA/local hospitals could be negotiated that would give a cost savings for the VA and benefits to the local community where the doctors/hospital can then treat the patient and no outflow is needed for his familymembers (including cost of lodging and living expenses).