I continue to believe that health care is a right, not a business.
Diane over at Cab Drollery: “A place for a tired old woman to try to figure things out so that the world makes a bit of sense.” We find a bit more evidence of what happens when profits come before people.
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.
There is a rat here somewhere. Either these hospitals have been dragooning elders into un-needed and un-necessary rehabilitation on a massive and unprecedented scale, turning entire hospitals into giant engines of fraud…
Or the auditing company is being too aggressive and retroactively denying huge number of legitimate claims.
Which could it be?
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.
More on “recovery auditing” here.
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. …
One last bit of wisdom from the comments to the original post at Cab Drollery…
VizierVic says, “Bulls make money, bears make money, pigs get slaughtered.”