Monday, November 26, 2007

Putting A Bounty On Our Elders

At the end of September, I posted on how some private contractors for a Medicare audit had turned into bounty hunters eagerly savaging the bills of rehab hospitals providing services to Medicare beneficiaries. The audit was a trial run ordered by Congress and involved three states: California, Florida, and New York. In California, records show that the auditors routinely rejected bills (up to 90%) from those rehabilitation hospitals providing services to those who'd had total knee or total hip replacements. As a result, several of those hospitals have closed or are about to.

Well, it appears that the other two states involved in the test have noticed the same sort of problem, although not to the extent that California has noted, according to this article in today's Sacramento Bee.

Florida and New York hospital officials are leaping onto legislation sponsored by California lawmakers that would temporarily halt a controversial Medicare auditing program.

The commission-based program has been operating for more than two years on an experimental basis in the three states and is set to expand permanently to 20 more in March.

But because of the California experience – in which rehabilitation hospitals have been forced to surrender tens of millions of dollars for past services deemed by auditors to be medically unnecessary – Democratic Rep. Lois Capps of Santa Barbara and Republican Rep. Devin Nunes of Visalia recently introduced legislation that would place the program on a one-year moratorium to investigate the problems. ...

Among the biggest concerns is that the congressionally created program relies on "recovery auditing" – auditors who are paid a percentage of the money they recoup from hospitals through claims denials.

"This contingency fee or bounty mechanism sets some incentives for these auditors to be overly aggressive and to make questionable decisions in their favor by denying claims," May said.
[Emphasis added]

Imagine, denying medically necessary health care to our elders in order to turn a buck, because that's really what this is all about. PRG-Schultz, the government contractor doing the auditing in California, claims that they recognize the necessity for therapy and rehab treatment and are just denying the 'unreasonable' part of the bill. 90% of the bills are unreasonable? Oh, please. What this is really all about is getting a cut of each bill that is denied, thereby driving those caregivers into the ground and clearing a hefty audit fee at the same time.

Two of California's congresscritters have sponsored a House Bill to suspend this test, but, given the current agenda in Washington, DC, the Capps-Nunes bill hasn't much chance to pass a stand-alone bill at the present time. The hope is that it will be added to another bill that hopefully will pass before the March 1, 2008 deadline to put the audit in force for the entire nation:

But with Congress under pressure to enact legislation before Jan. 1 to stop an automatic cut in Medicare fees paid to physicians, advocates see an opportunity for the bill to be merged into a larger Medicare package.

Please raise a little hell with your congresscritters now, next week, and the weeks after that. This kind of corruption really has gotten out of hand when it involves our elder parents and grandparents.

Note the First: the private contractor doing the audit in California is PRG-Schultz. Among the investors in PRG-Schultz is Blum Capital Partners, headed by Richard Blum of San Francisco. Blum is married to Sen. Dianne Feinstein, D-Calif.

Note the Second: I am 61 years old and will be a Medicare beneficiary in less than four years.

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Blogger VizierVic said...

This doesn't even pass the smell test. 90% unnecessary? Come back when you make it believable.

These pricks were too stupid to even realize that if they had passed the reasonable test (say in the 10% to 15% range) they could have pushed this program to go national without a hitch, with almost no oversight. Now, they get dumped and maybe even sued. That old aphorism expressed on Wall Street serves here: "Bulls make money, bears make money, pigs get slaughtered."

3:24 AM  
Anonymous Anonymous said...

thank you for bringing this to my attention. i will pass it on to as many folks as i can.

feinstein needs to be more selective about the company she keeps. perhaps she needs a husband and heart replacement and lots and lots of rehab.

i would have thought this a scam from the repelican swine but to learn it is coming from those i hope will save the world from neocon/any randian idiotology is most depressing.

4:11 AM  
Anonymous Anonymous said...

oh god....feinstein's husband AGAIN...

4:20 AM  
Anonymous Roddy McCorley said...

Note the Second: I am 61 years old and will be a Medicare beneficiary in less than four years.

You hope.

5:35 AM  

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