Monterey, CA Medicare & Medi-Cal Looking Into Overbilling For Unnecessary Procedures

View From A Non-Profit Serving Carmel, Carmel Valley, Gonzalez, Greenfield, King City, Marina, Monterey, Pacific Grove, Pebble Beach, Salinas, Seaside And Soledad California I wrote yesterday on my blog about HCA Healthcare being under investigation for billing for unnecessary procedures.  Physicians are unlikely to be able to get away with this in the future.  The new Health Care Reform law (the Affordable Care Act) provides checks and balances, one of which is giving Medi-Cal more authority to track and reject payments for medical procedures which they believe are being over-utilized.  The law also calls for making medical records electronic which should allow doctors to eliminate doing tests which may have already been performed by another physician.  Many of the elderly have multiple doctors, and they don't always communicate well with each other.  "The health care law is helping us implement new incentives for doctors, hospitals and health care providers to provide better quality care, not just a greater quantity of services," Medicare spokesman Brian Cook told USA Today.  In 2010, the Department of Health and Human Services said that $48 billion was paid out improperly from the Medicare fund for unnecessary procedures and tests, medical errors and things which lacked proper documentation to justify the cost.  I have mixed feelings about the new rules.  On the one hand, it's clear that we need to do something to cut the costs that Medicare and Medi-Cal are paying out.  But on the other hand, I don't think Medicare, Medi-Cal or private insurance companies should have the power to veto a test which the doctor and the patient both believe will help them.

Please note that this blog reflects my personal opinion and may or may not reflect the opinion of HandsTo Help Seniors and the individual members comprising the Board of Governors.