Tuesday, December 15, 2015


Ripping off


MY MEDICARE INSURANCE company, AvMed just sent me a notice that it paid a doctor $343.00 on a bill of $350.00.

My co-pay was zero.

So why am I complaining?

I WAS IN THE hospital overnight for a "fem-pop bypass" to bypass an aneurysm.

I was admitted Wednesday morning and discharged Thursday evening.

The surgeon chatted with me before the operation (he's cut on me before) and he had me as a "show-n-tell" for some floor nurses and one of his partners the next day.

Today, AvMed informs me it paid another physician $343.00.

I never saw the physician.

Neither my wife nor son, who were with me, saw any physicians other than the surgeon. The Spouse supposes that this doctor's nurse came by to say "Hello," but I don't recall any nurses or nurses' aids that were not identified on the huge white board on the wall.

Again, my co-pay for this invisible doctor's visit was $0 - nada, effis, nothing.

BUT I THINK MEDICARE - FUNDED BY MY TAX DOLLARS - IS GETTING RIPPED OFF; the doctors who bill for visits not made are thieves.

Maybe this phantom physician has to make his payments on a prestigious car; my surgeon drives a leased Jaguar - we chat about cars and other topics between surgeries.

I may not have a co-pay, but in the end, I am - and all tax-payers are - paying for services not rendered. That, plain and simple, is theft.

Maybe $343.00 is a pittance to AvMed, too little in the grand scheme of things to investigate. But consider: if you add up phantom physician visits at one a day times 256 days (52 5-day work weeks) time $350 (the fee billed) the Grand Total is a healthy $91,000 (91 thousand). Granted that's probably peanuts for a lot of doctors and they do have debt - college and medical school aren't inexpensive, even the off-shore schools can be pricy.

Mind, that $91,000 total is for ONE visit to ONE patient for ONE day. Any invisible doctor should be able bill for 8 to 16 "visits" per day. Think about it: $350 times 12 "visits" per day and our phantom physician has billed Medicare or some other insurance company $4,200 - and the doctor may not have set foot in the hospital.

Even if the doctor sends a nurse in his or her stead, the doctor still is raking it in; nurses, as important as they are, don't get the dollars doctors do.

It's fraud, Medicare fraud, and while Medicare,gov preaches "report fraud," I suspect when fraud is reported, the individual fraud - e.g., $350 - is just to picayunish for the government to consider. The Medicare budget for 2014 was $511 billion.

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