Editorial: Time to rein in Medicare overbilling

No wonder so many Americans are skeptical about the federal government's ability to wisely spend their money. A new report shows it spent billions more on Medicare than it should have for doctors' visits and patient evaluations. Yet the government says it would cost too much to hold doctors accountable for overbilling. That is irresponsible, and Washington must find a cost-effective way to monitor Medicare billings and root out unjustified costs.

Medicare overspent by $6.7 billion for office visits and patient evaluations in 2010, according to a report by the Department of Health and Human Services. The overpayments account for 21 percent of the $32.3 billion spent on evaluation and management services in 2010, a category that includes office visits, emergency room assessments and inpatient hospital evaluations. The inspector general called for more oversight on these services after a 2012 report revealed that doctors had increasingly billed Medicare for more expensive office visits over time.

Yet the Centers for Medicare and Medicaid Services says it would be too expensive to review physician's billings. By failing to hold doctors accountable, the government is wasting taxpayer dollars and ignoring evidence of exorbitant waste. There has to be a better way than willful indifference.

The Tampa Bay Times reported when health providers in Florida billed Medicare for nearly 19 million visits in 2012, they listed the top fee less than 5 percent of the time. But a small concentration of doctors in the state routinely asked for the highest fees, incurring the most costs to Medicare. About 160 doctors and medical providers claimed nearly all of their patient visits merited the highest rating on a 1 to 5 scale. Another nearly 425 providers billed nearly half their office visits at that rate.

Receiving large Medicare payments doesn't necessarily indicate, but it does raise red flags. CMS agreed with a recommendation by the inspector general's office to educate doctors about proper billing practices, but it would not agree to routinely review doctors' Medicare billings. This sends the message that physicians have a license to bill without consistency or reason, and that those who freely abuse the system won't be detected or punished.

If it costs too much to individually monitor Medicare billing, then the government must find another way to check unfettered spending. Medicare has enough trouble remaining financially viable without wasting billions on unjustified bills, and Americans expect government to spend their money responsibly.

Editorial: Time to rein in Medicare overbilling 06/05/14 [Last modified: Friday, June 6, 2014 6:32pm]

    

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