It's time Medicare clamps down on fraud
With access to the Medicare claims database to track Medicare expenditures, the Wall Street Journal recently reported, as part of a series on Medicare expenditures, that the Norton Hospital in Louisville, Ky., performed the third-most spinal fusions on Medicare patients in the country!
The story was prompted by whistle blowers from Medtronic, Inc., the manufacturer for hardware used in spinal fusions, who testified that the company had paid “royalties” when physicians used their hardware for spinal fusions.
One surgeon at Norton Hospital had royalty-bearing agreements with Medtronic since 1996. The company paid him more than $27 million from 2001 to 2006, according to internal Medtronic documents reviewed by the Journal. On its website, the company disclosed paying him another $13 million in royalties in the first three quarters of this year alone.
Although these “arrangements” definitely pose a conflict of interest and may be illegal, why didn’t Medicare investigate the outrageous number of fusions that were performed at this hospital? It was right there in their database! And, what about all the other unnecessary procedures, like the tens of thousands of cardiac stents implanted into patient's hearts? Why collect data if you're not going to use it?
Listen to this – from 2004 to 2008, Medicare paid Norton Hospital $48 million for 2,475 spinal fusions it performed on Medicare patients. This town must have lots of backaches! Why didn't these numbers raise a red flag at Medicare?
Besides the 100,000 deaths that result from unnecessary procedures each year, they add $700 billion to our healthcare costs! That’s one-third of our total healthcare costs! Yet, Medicare has to be pushed into action by whistle blowers and articles like those in the Journal. With these data, you don’t need FBI sting operations, you just need to look at it, identify the offenders and prosecute them.
Another way the data could be useful to prevent fraud is to publish a list of individual physician billing practices. That way we can see for ourselves how our doctors check out before signing any consent forms. The problem is Medicare is prevented from making the data public. The American Medical Association successfully sued the government more than three decades ago to keep secret how much money individual physicians receive from Medicare.
This lack of transparency is pervasive throughout the healthcare system. I don’t know about you, but I don’t want to go to a doctor who performs countless numbers of unnecessary procedures so he can bilk taxpayers for millions of dollars and receive “kick backs” from medical device companies.
But, how do we find out which physicians are honest?
All we can do right now is hope that investigative reporters such as those at the Journal expose these crooks for who they are and embarrass Medicare into doing something about them. Also, we can ask our doctors about whether they receive kickbacks from manufacturers before we give consent to any procedures. Never mind bankrupting the system – our lives are at stake whenever we go to these unscrupulous “practitioners”.
Jeffrey Kreisberg blogs regularly at takingcontrolofyourhealthcare.com
