THE CONTEXT BEHIND THE SIX DOCTORS HAVING TO RERUND PAYMENTS FOR MEDICAL SERVICES

If you read the post in the Herald, no doctor has been charged with criminal conduct.  Why? it was a billing problem which was caused by equally responsible doctor's staff and staff at Medicare, Medicaid, and TRIWEST. 

Just yesterday, while praising the urologist the VA assigned to me, I noted the staff is a nightmare.  To be sure the doctors need to be held accountable for the mistakes of their billing staff. But also note doctors do not prepare the billing to the various public and private insurance companies.

I will not name the doctor I use to see but stopped because his staff was a nightmare.  I spend years making good money advising doctors on liability problems to include billing mistakes.

The doctor I know is brilliant.  When my later brother-in-law was in ICU at Valley Baptist, he saved him.  The ICU staff were ignoring the lab work, and this doctor stepped in and had a word with the ICU nurses.

This doctor is brilliant and no one will ever convince me he was part of this mess.  In fact, I equally blame Medicare, Medicaid and TRICARE for what happened. 

You will note TRIWEST [VA] is not included.

As I have noted I see how much the doctor bills and how much they get paid.  Routinely, I see simple procedures tied to the treatment wherein the VA denies the claim.  The office managers express their frustration.  

I left this doctor after his office manager refused to release my medical records to Brooks Army Medical Center.  The agreement with the VA is medical records are to be released at no cost, if general records.  Once Brook Army Medical Center gave up on getting the records they dropped me as a patient. The doctor did nothing wrong, it was his staff.

CONTEXT: Doctors have to rely on their office manager to manage the non-medical staff.  Unfortunately, billing has become so complex. The coders are no longer qualified. They are not getting the training they need.  And what happened to these 6 doctors is the result.  But there is certainly no intended fraud by the doctors.

WHY MEDICARE, MEDICAID AND TRIWEST ARE EQUALLY RESPONSIBLE

If the DOJ press release is correct, Medicare, Medicaid and TRIWEST paid for services not justified because the doctor's medical notes did not say why the simple test was performed.  If Medicare requires justification for the procedure, and justification is not in the record, why did Medicare pay for it?

The Medicare, Medicaid, and TRIWEST clerks were no more competent than the coders working for the doctors.

And this my friends is why no one was charged with criminal fraud.

Please do not judge these doctors based on the mistakes of their coder billing for the service, and for the Medicare. Medicaid, and TRIWEST clerks paying for the services when the medical records did not justify the billing.

Billing problems are routine.  This one got out of control because Medicare, Medicaid and TRIWEST paid when they should not have.  Had the billing been denied based on incomplete medical records, doctors would have corrected the problem.

Yes, I agree the doctor should have to pay the money back, but the Congressional Oversight Committee needs to look into this matter so they can see how the mistakes of Medicare, Medicaid, and TRIWEST are costing the taxpayers millions. 

Back to work, before leaving for a doctor in McAllen.