Medicare Overspends By Billions on E&M Services

Based on a new report from the inspector general of the U.S. Department of Health and Human Services, Medicare spent $6.7 million more than necessary on doctors’ office visits and other patient evaluations in 2010. However, the Centers for Medicare and Medicaid Services announced that it has no plans to review doctor billings because it would not be cost effective.

Of course, this only opens the door for doctors and hospitals to continue to fraudulently submit claims for government funds. The inspector general’s report estimated that overpayments accounted for a whopping 21 percent of the $32.2 billion spent on evaluation and management services in 2010. This includes emergency room checkups, in-patient hospital evaluations and basic office visits.

In making this report, the inspector general assembled medical records associated with 657 Medicare claims and asked expert coders to determine whether or not the services matched with the rates charged. In total, more than half were billed at the wrong rate or lacked proper documentation to justify service.

While there were some physicians who did not bill high enough, most were billing too high. The inspector general used the information gathered through the small sample to determine the amount Medicare overpaid on all 2010 E&M claims.

These findings fall in line with data extracted by ProPublica from 2012 Medicare claims. ProPublica found that more than 1,800 physicians and other health care professionals almost always billed Medicare for the most complicated and expensive office visits.

Despite this information, the CMS disagreed with the suggestion that they should review physician billing. The agency claimed that it cost too much money and man hours to get through each claim and that the potential return would not be worth the effort.

This puts the power in the hands of consumers, nurses and other healthcare professionals. Healthcare fraud leads to potential hike taxes, which no one wants. People working at doctors’ offices or hospitals where people are trying to game the system and fraudulently over charge for Medicare services have the power to blow the whistle and stop them from stealing money from the government and from physicians who legitimately need the funds.

The qui tam attorneys at Begelman & Orlow, P. C. have more than 115 years of combined experience litigating whistleblower cases throughout the U.S. If you have knowledge of any fraudulent activity or wrongdoing, contact the whistleblower lawyers at Begelman & Orlow, P. C..