When I announced on my favorite physician Web board that I had mailed discharge letters to five patients solely because they have Medicare my colleagues hailed me as their "hero."
I don't feel like a hero.
I opted out of Medicare years ago, but Medicare requires physicians who have opted out to write a letter reaffirming that status every two years. Last year I realized it might have been four years, so I dashed off a letter and waited. You can imagine my shock when, on February 10, 2012, I opened a letter from "Darla" (no signature or last name) dated August 4, 2011, but with no postmark on the envelope. Darla writes that my "affidavit does not meet CMS requirements." (What affidavit?) She goes on in her 6th grade English: "Opt Out Affidavit was unable to be processed. We did not receive the requested information in a timely manner. A request for information was sent June 13, 2011 to apply for a Type 1 NPI number." (If Darla intends to say Noridian, the Medicare administrator for my area, sent that information to me, I never received it, and I already have some type of NPI number.) Then she writes that I need to use my "Legal Name" when "filling out the information." (How does one "fill out information?")
I called Noridian provider enrollment to investigate. "April" reminded me that treating these Medicare beneficiaries without opting out subjects me to prosecution. I don't want to go to jail, although at least there I might have a right to free medical care.
I sent discharge letters to 5 patients and asked my office manager to call them to warn them in advance. Now I am completing a Medicare DISenrollment form. In the future I will require all new patients to demonstrate that they do NOT have Medicare.
Showing posts with label medicare. Show all posts
Showing posts with label medicare. Show all posts
Thursday, February 16, 2012
Sunday, June 26, 2011
Government sanctioned liars
New York Times: U.S. Plans Stealth Survey on Access to Doctors
According to the article factitious federal "shoppers" plan to call primary care offices to assess relative availability based on payer, like Medicaid, Medicare, insurance or direct (cash) pay.
Physicians should look at this as an opportunity to send a message to Washington: Starting now or in a "few months" stop accepting Medicaid and Medicare patients. Apparently docs can avoid the calls altogether by not accepting or returning calls from ID-blocked numbers.
Or send them to the ER.
According to the article factitious federal "shoppers" plan to call primary care offices to assess relative availability based on payer, like Medicaid, Medicare, insurance or direct (cash) pay.
Physicians should look at this as an opportunity to send a message to Washington: Starting now or in a "few months" stop accepting Medicaid and Medicare patients. Apparently docs can avoid the calls altogether by not accepting or returning calls from ID-blocked numbers.
Or send them to the ER.
Thursday, May 19, 2011
Patient Falsely Claims to Not Have Medicare. Doctor Goes to Jail.
Sounds absurd, doesn't it? And of course it really hasn't happened. Yet. As far as I know.
But it could happen in your lifetime. Here's how:
Patients regularly call my office asking whether I "accept Medicare." Until about a month ago we politely explained that I opted out of Medicare. This means the patient must agree in writing that neither of us will ever bill Medicare for services I provide and that the fee I charge is between me and the patient. We are not bound by the Medicare fee schedule. About a month ago, however, I decide to stop treating patients who are covered by Medicare altogether. (Why is another story.)
Many of the patients who call my office, when we tell them I do not accept Medicare, tell us they cannot find a psychiatrist in the area who does accept Medicare. The obvious solution? Lie. After all, what physician or office staff would suspect someone of claiming NOT to have coverage? What might we say? Prove it. I suspect not. And besides how could the patient prove he does not have Medicare coverage?
Why would a physician want to make sure the patient is not covered by Medicare? There may be stiff civil or even criminal penalties for failing to file a claim with Medicare unless the physician has opted out. So adopting a "Don't ask. Don't tell." approach involves considerable risk.
How would the patient know the physician does not accept Medicare patients, and thus must lie? My practice Web site front page clearly states that I do not accept patients who have Medicare.
I contacted the Office of Communications/Media Relations Group at Centers for Medicare & Medicaid Services and inquired whether any such cases have been prosecuted. Ellen B. Griffith, Public Affairs Specialist, responded:
"As to whether a physician would be prosecuted for failing to submit a claim for services to a beneficiary who lied about his status – CMS is not an enforcement agency. Prosecutions of violations of Medicare law are handled either by the Office of Inspector General or the Department of Justice. I would suggest you contact them directly."
I then asked, "Is there a way a physician can confirm that a prospective patient is not a beneficiary by accessing a database at CMS or other agency?" So far no response.
I admit this hypothetical situation seems unlikely, but its very plausibility suggests Medicare badly needs fixing, and soon. You can join the conversation with seniors at AARP.
But it could happen in your lifetime. Here's how:
Patients regularly call my office asking whether I "accept Medicare." Until about a month ago we politely explained that I opted out of Medicare. This means the patient must agree in writing that neither of us will ever bill Medicare for services I provide and that the fee I charge is between me and the patient. We are not bound by the Medicare fee schedule. About a month ago, however, I decide to stop treating patients who are covered by Medicare altogether. (Why is another story.)
Many of the patients who call my office, when we tell them I do not accept Medicare, tell us they cannot find a psychiatrist in the area who does accept Medicare. The obvious solution? Lie. After all, what physician or office staff would suspect someone of claiming NOT to have coverage? What might we say? Prove it. I suspect not. And besides how could the patient prove he does not have Medicare coverage?
Why would a physician want to make sure the patient is not covered by Medicare? There may be stiff civil or even criminal penalties for failing to file a claim with Medicare unless the physician has opted out. So adopting a "Don't ask. Don't tell." approach involves considerable risk.
How would the patient know the physician does not accept Medicare patients, and thus must lie? My practice Web site front page clearly states that I do not accept patients who have Medicare.
I contacted the Office of Communications/Media Relations Group at Centers for Medicare & Medicaid Services and inquired whether any such cases have been prosecuted. Ellen B. Griffith, Public Affairs Specialist, responded:
"As to whether a physician would be prosecuted for failing to submit a claim for services to a beneficiary who lied about his status – CMS is not an enforcement agency. Prosecutions of violations of Medicare law are handled either by the Office of Inspector General or the Department of Justice. I would suggest you contact them directly."
I then asked, "Is there a way a physician can confirm that a prospective patient is not a beneficiary by accessing a database at CMS or other agency?" So far no response.
I admit this hypothetical situation seems unlikely, but its very plausibility suggests Medicare badly needs fixing, and soon. You can join the conversation with seniors at AARP.
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