Cracking the Medicare [over]billing codes

Judging by their bills, it would appear that elderly patients treated in the emergency room at Baylor Medical Center in Irving, Texas, are among the sickest in the country — far sicker than patients at most other hospitals.

In 2008, the hospital billed Medicare for the two most expensive levels of care for eight of every 10 patients it treated and released from its emergency room — almost twice the national average, according to a Center for Public Integrity analysis. Among those claims, 64 percent of the total were for the most expensive level of care.

But the charges may have more to do with billing practices than sicker patients. A Baylor representative conceded hospital billing for emergency room care “did not align with industry trends,” but said that the hospital since 2009 has reined in its charges.

The Texas hospital’s billing pattern is far from unique. Between 2001 and 2008, hospitals across the country dramatically increased their Medicare billing for emergency room care, adding more than $1 billion to the cost of the program to taxpayers, a Center investigation has found. The fees are based on a system of billing codes — so-called evaluation and management codes — that makes higher payments for treatments that require more time and resources.

Use of the top two most expensive codes for emergency room care nationwide nearly doubled, from 25 percent to 45 percent of all claims, during the time period examined. In many cases, these claims were not for treating patients with life-threatening injuries. Instead, the claims the Center analyzed included only patients who were sent home from the emergency room without being admitted to the hospital. Often, they were treated for seemingly minor injuries and complaints.

While taxpayers footed most of the bill, the charges also hit elderly patients in the pocketbook, increasing the amount of their 20-percent co-payments for emergency room care.

Asked if the hospital returned Medicare overpayments, Baylor Irving’s president, Cindy Schamp said it has not. “To date, we have not made any payments back to Medicare,” Schamp wrote in response to questions. “However, continuing to work to do the right thing, we feel it is appropriate to review.”

Long, very detailed, worth reading and re-reading.

I post articles here with some frequency about Medicare fraud, healthcare fraud. The articles that reach the surface of the scum sitting atop American healthcare practices generally concern individual physicians, the odd cluster of group practice thieves, scumsuckers who feed off the lives of ailing and dying Americans. Obama’s lead on digitizing medical records and feeding the info into formats useful for data mining are producing a refined understanding of just how much ethical standards have diminished in the United States.

Grayheads especially have to develop a habit of reading those periodic statements that arrive in the mail or online from Medicare. It’s not uncommon in my experience to find a medical procedure double-billed, triple-billed. It isn’t unusual to find a bill that starts out with two minor procedures expanding to three or four by the time each specialist gets a shot at including their added take.

The Office of the Medicare Ombudsman can help you if you have a complaint about your quality of care. That includes overbilling, false billing, questions you have about the facility you deal with raising the care they provided to a classification above the actual service. Call 1-800-MEDICARE and ask for the OMO – the Office of the Medicare Ombudsman or go online for more details.

Not so incidentally, the Feds will give you a $1,000 reward if you spotted something they truly need to put a stop to.

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