Local hospital's fraud shows health care system's ills

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Posted on the 29th of April, 2011

Just read an article about a local hospital and its parent company (a collection of mega-hospitals) being investigated for fraud. They allegedly have been overbilling Medicare, Medicaid and private insurance for millions of dollars more than the work that they did. What a shame. They will take a major financial hit and potentially loads of irreparable media exposure. Two questions come to me:

1. Do people really care?

2. Do we blame the hospital (sure), but what about the system?

Who Cares?

People largely will could care less about this case of fraud because they were not victims directly. When you create a cost-blind system, where neither the customer, nor the business have any clue what things cost, no one really gets "hurt". Sure, we all lost on this deal because we ultimately bare the burden of escalating healthcare costs and taxes, but no one personally feels cheated by Lutheran Hospital. We need to bring a much greater awareness to the cost of healthcare. People, on both sides need to realize how much money these medicines, surgeries, interventions (too many of which are unnecessary and quite harmful) cost.

I left the insurance world when I started GladdMD. I did that because insurance reimburses the better physicians for seeing a high volume of patients per day (around 30 on average to make the average wage, but the number needed to see is rising) and doing procedures. I do not do either of these things. I sit with patients for an hour, sometimes longer if they need it, so when I was with a hospital in an insurance-based practice it was in the red every month. In order to practice the type of medicine I wanted, I needed to work more like a lawyer, being paid for my time. I charge what I believe is fair and what allows me to spend time with my family and make a decent wage like the average family physician (the wage part that is, I spend a lot more time with my family then they do). Because I practice this way, some view us as expensive care. The truth of the matter is, if you knew how much your care really cost dollar-wise, we're the best bargain in town. A one-hour visit with our integrative practitioner to truly promote your health and empower you to feeling and being well is cheaper than the average 10 minute fast-paced, prescription-receiving visit your getting now.

Who's to Blame?

Blame both. There is no excuse for intentionally billing an insurance company for work that was not done. I suspect the punishment will be severe. But don't forget about the system that has been created. This disease-care system we have is very expensive, partly because your rewarded for using expensive testing and doing expensive procedures, and partly because the malpractice landscape has raised a bunch of physicians to practice defensive medicine. We are taught from medical school on that instead of, "Do no harm", we also need to "Get no sued". The expense of this care is not sustainable. The answer? Cut reimbursement across the board. The reimbursement from Medicare is pennies on the dollar. It is extremely sad, but we are in a time where caring for our nation's elderly is essentially charity work and good business practice would suggest you should not do it.

I am not sure what the ultimate cure is, but I can assure it starts with investing, from both the payer's (Medicare, Medicaid, insurance) and customer's (patient) side in true healthcare. Helping people connect their conditions and concerns to their lifestyle and providing the tools and resources to do such. I can assure you that the majority of folks that come to see us and other integrative providers and make this investment, cost both their own and their insurers significantly less money over within a year. And to spend time with patients and survive we bill the patient directly. Just good, honest business. Isn't that what this country is supposed to be about?