One Way to Eliminate Medicaid Waste in The United States

In the United States, cuts to the public health insurance program Medicaid have been made which impact patients negatively. But a simple way to eliminate waste was ignored.

Image via Wikipedia

Recently cuts were made to Medicaid and Medicare spending which caused many patients to lose their doctors, because these doctors could no longer afford to participate in the Medicaid system. Now there is a very small pool of mostly untrained or foreign-trained doctors for these patients to choose from, and in many instances they will go from receiving quality care - which in itself cuts costs - to receiving substandard care, which will unfortunately cause their conditions to worsen, counterproductively costing even more money to the Medicaid system.

This Catch 22 could have been avoided if steps were taken to set some rules on doctors who participate in the system before making such drastic cuts. Medicaid officials could have started out by surveying patients to determine exactly what kind of care in some instances they were receiving, and they would have found this:

The biggest waste of money in the Medicaid system is overbilling. Many Medicaid doctors - the poorly trained mentioned above - will have a patient in for an office visit and only address one issue of many that the patient has, then insist the patient make another appointment for each individual issue that patient needs addressed, no matter how small. This is because that doctor can then bill Medicaid the maximum office visit amount for each malady, even though several maladies (a head cold, migraines, a swollen foot) could be addressed in the same visit. By separating these issues into separate visits, the doctor is able to bill three times as much than if the issues were all handled in the same visit. Medicaid must pay three times as much, and the only one coming out on top is the doctor. Medicaid is out of pocket much more money than they would be, the patient has to come up with more transportation, not to mention suffering the several months extra wait time to have his or her problems addressed, during which time these conditions can worsen - again costing more money to treat than if they had been addressed proactively.

Another spin on this tactic is to write the patient a prescription for a medication that can be refilled - say, a blood pressure medication - and not allow refills for it, so that the patient will have to come back every 30 days to get a new prescription. While this is common practice for prescriptions that are controlled substances and by law cannot be refilled, it is intentional robbery to do this when the medication is one that allows refills. In that case, it is just an excuse to get the patient back into the office, where another unnecessary office visit fee (plus any other fees that can be tacked on at the last minute) can be billed to Medicaid.

Having interviewed several people in my neighborhood who are personally on Medicaid for this article, I can tell you with assurance that these practices are in fact rampant in the system. The only effect that the recent Medicaid cuts have had is causing heartache for the patients in the system who have lost doctors they trusted, doctors it took them a long time to find. They will now be forced to go to these "quacks" who see them only as walking dollar signs and care nothing about healing these patients so that the patients might be able to go on to become more productive members of society.

One young woman I spoke with said that she had written several letters to her congressman, as well as the President himself, about the practice of office visits every 30 days for refills on non-controlled substances but had heard nothing back. She now feels that she has no voice, even though she has voted in every election, local and national, since she turned 18. She is very discouraged and now avoids going to the doctor at all because she lost the doctor she trusted, and the new doctor she has been assigned does not listen to her and makes her come back every 30 days for refills, even though transportation to his office presents a very real hardship for her. This young woman has a dangerous heart condition that could be fatal without proper medical attention, but because of these cuts she is now missing her doctor visits. The prognosis is not good for her. And I would imagine there are probably many more young women like her out there.