Friday, September 26, 2008

Diagnosis Code "Z"

Patient - "Well doc, how bad is it?"

Doc - "It appears you have zzzzzzzzzzzzz."

Patient - "Is that bad?"

Doc - "Hard to say. But don't worry. Medicare has you covered."

The government paid more than $1 billion in questionable Medicare claims for medical supplies that showed little relation to a patient’s condition, including blood glucose strips for sexual impotence and special diabetic shoes for leg amputees, congressional investigators say.

Billions more in taxpayer dollars may have been wasted over the last decade because the government-run health program for the elderly and disabled paid out claims with blank or invalid diagnosis codes, such as a “?” or “zzzzz.” Medicare officials say even smiley-face icons could have been accepted.

OK, compared to the Wall Street mess, a billion dollars seems like chump change. But it does make you wonder if anyone in Washington is minding the store.

I mean, smiley-face icons and shoes for amputees? Give me a break.

The report by Republicans on the Senate Homeland Security investigations subcommittee, obtained by The Associated Press, is the latest to detail lax oversight in the $400 billion program that has been cited by government auditors as a high-risk for fraud and waste for nearly 20 years.

Going on for 20 years. That's 10 years before the mortgage mess got started . . . courtesy of, you guessed it, the folks in Washington.

The panel’s review of millions of claims submitted by sellers of wheelchairs, drugs and other medical supplies on behalf of Medicare patients from 2001 to 2006 found at least $1 billion in which the listed diagnosis code appeared to have little, if any, connection to the reimbursed medical item.

Doc - "Looks like you have a touch of flu. What do you say I write a prescription for one of those scooters?"

Other questionable claims included wheelchairs or wheelchair accessories for patients listed as having a deformed nose or sprained wrist;

Questionable claims . . . but they were paid any way.

CMS has acknowledged that its medical equipment program is susceptible to fraud and waste, estimating in 2007 that $1 billion of the roughly $10 billion in Medicare payments over a one-year period were improper. A recent report by the HHS inspector general suggested that annual waste could actually be as high as $2.8 billion, citing particularly shoddy government oversight.

Guess it's a good thing Medicare isn't in the lending business.
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