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Jewish World Review Dec. 29, 2006 / 8 Teves, 5767 Medical Thoughts for 2007: Medicare bounty hunters unleashed. Patients should plan for More Physicians to Opt out of Medicare By Drs. Michael A. Glueck & Robert J. Cihak http://www.JewishWorldReview.com | Contrary to popular belief, the word "disinterested" does not mean "uninterested." It means having no personal financial stake in the resolution of an issue. But "disinterested" doesn't mean you can't get passionate about something. And of all the issues that exercise your (retired from active practice) Medicine Men, this is among the greatest: The more medicine there is, and the better it gets, the harder it becomes for people to access it. Not just because of cost or insurance (or lack thereof), but because the federal government makes it so by straitening and attacking the providers. Straitening and attacking them to the point where more and more physicians are opting out. The year 2006, like most years, has been one of great advances in medical diagnosis, therapy and futuristic medical technologies. However, these advances may never reach those who need them most, the elderly, if many more practicing physicians choose to opt out of Medicare. In a few years, millions of covered patients may find themselves doctor-less or, almost as bad, served by physicians and organizations overwhelmed by patients. In the past we have written endlessly (or so it sometimes seems) about burdensome federal red tape, paperwork and controls: HIPAA, onerous Medicare regulations, limitations on prescribing legal pain medications, and the cutting of already inadequate reimbursement. Here we take our customary swipe at the lawyer legislators who churn out these fetters, pausing only long enough to note that, more and more, Congress is home to former prosecutors - and the "guilty until proven innocent" mindset they so often seem to carry. Now, however, comes the congressional "enforcement" scheme that may lower your life expectancy, hurt your health and drive your doctor into early retirement or some other line of work. Please pardon the pun, but the fed. may well end up breaking American medicine on the RAC. "RACs" are Recovery Audit Contractors, private entities paid by the government to audit Medicare Claims, including Part A, Part B and home health care and hospice services. Fair enough: auditing is a legitimate government function. But "RAC's" are paid on a contingency fee (plus bonus) system: The more "fraud" they find, the richer they get, and this applies to both overpayments and underpayments. These include alleged unnecessary treatment, improper coding and various technical secondary payer issues. However, the AMA (no enemy of the government) has complained that RAC methods are draconian and time-consuming and that, because of the monetary incentives to find malfeasance, they're essentially bounty hunters. Many providers also complain that RAC auditors don't understand complex and endlessly changing Medicare rules and are not qualified to pass on medical necessities since they're not physicians or specialists themselves. Imagine somebody with no knowledge of automotive mechanics, and who hasn't even seen your car, passing judgment on what repairs were necessary and what they should have cost. It gets worse. The new Congress, controlled by Democrats, is expected to ratchet up "enforcement." Among the anticipated changes: greater reliance on civil monetary penalties over criminal action. Although this sounds like an improvement, it is not. The standard of proof is less in civil actions, -preponderance of evidence," not beyond a "reasonable doubt" and in this case it's far more lucrative for the government to haul in the cash than haul off the bodies. Also, such cases go before an administrative law judge, where there is less due process for the physician or provider. And, of course, should Senator Clinton find herself back in the White House in 2009, this time as a salaried government employee, can another push for full state medicine be far behind? So what we have here is yet another imminent attack on the medical profession's ability to provide adequate care. But there's a saying in Washington, DC: "Nothing succeeds like the right kind of failure." Ever since 1965, every time a federal medical program has gone wrong or costs exploded, the federal answer has been, more laws, more regulations, and more programs. Set up an impossibly complex, unworkable system, then punish people for not being able to abide by it. A perfect prescription for wrecking the system in order to take it over. Or, as the Vietnam slogan went, "We had to destroy the village in order to save it." Editor's Note: Michael Arnold Glueck, M.D. wrote this week's commentary. Every weekday JewishWorldReview.com publishes what many in in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here. Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here. Archives © 2006,

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