The American Association of Retired Persons, the U.S. Justice Department and HHS' inspector general's office have unleashed a new volunteer army.
As a result, from now on that Medicare beneficiary in a physician's office could be trying to ferret out fraud, error and waste.
The AARP and the feds last month launched a campaign called "Who Pays? You Pay!" which will train some of the 39 million Medicare recipients to monitor their medical benefit statements and question odd, mysterious or duplicate billing. Representatives of the 17-million-member AARP are leading the training.
In February HHS Inspector General June Gibbs Brown estimated that $12.6 billion of Medicare's budget is wasted on fraud, error and abuse, but added that she doesn't know how much of that amount is fraud.
Even before the Feb. 24 kickoff of the campaign, the American Medical Association staged a counterattack, slamming the effort as counterproductive and an intrusion into the patient-physician relationship.
In a prepared statement, AMA President Nancy Dickey, M.D., said that while the AMA has zero tolerance for fraud, the government's tactics are lamentable. "It's like saying, 'There's a bad apple in the barrel. Let's throw out the whole barrel . . . . To drive a wedge between physicians and patients is unconscionable. In the patient-physician relationship, trust is paramount."
She said the government effort "trivializes real fraud and creates an adversarial tone in every physician- patient encounter."
Malcolm Sparrow, a professor at Harvard University's Kennedy School of Government and the author of License To Steal: Why Fraud Plagues America's Health Care System, said if the AMA genuinely has zero tolerance for healthcare fraud, it should be more receptive to government efforts to fight it. The association's response "leaves the overall impression that the medical establishment is vehemently opposed to all government efforts in this direction."
Sparrow added, however, that efforts to mobilize patient assistance in detecting and preventing fraud should not be a substitute for "serious re-evaluation of claims processing and program integrity measurements used by public payers on major public programs."
That responsibility should remain with payers, not patients, he said. "I'm for burden-sharing, not burden-shifting."
The AARP said the campaign is intended to educate its beneficiaries, not drive a wedge between patients and doctors.
"No one can fight Medicare fraud unless we all do this together," said AARP spokesman Greg Marchildon.
He said the association, with 30 state offices and 5,000 chapters, offered 37 training workshops around the country to more than 6,000 members in recent weeks. The association gives federal officials a huge volunteer corps to spot billing problems. The AARP plans more than 100 future training sessions, which include videos on health fraud and a crash course in reading medical bills.
"This is not an anti-provider campaign," Marchildon insisted. "We're not quite sure why the AMA is so apoplectic about this. Part of the doctor-patient relationship is feeling comfortable asking questions about your bills."
Randolph Smoak, an Orangeburg, S.C., surgeon and the chairman of the AMA board of trustees, said it's appropriate to ask patients to look at their bills.
"But those are very complex, and therein lies the problem. The government is taking the most vulnerable citizens and asking them to sort this out. You can't go line by line through an explanation of medical benefits with a hospital chief financial officer and get a clear reading, so how can you ask an untrained senior citizen to do that?" he said.
Lou Pare, a 65-year-old retired government contract negotiator who lives in Dracut, Mass., was among those trained to read his Medicare statements.
"I wonder how many people receive their bills and just throw them away," Pare said. "There could be an error, a duplication or even fraud there. And with all the billing going on, there's a great deal of money wasted that could be spent to make Medicare stronger and more solvent."
Pare, a cancer survivor, said he'll discuss the program with his urologist, whom he described as "a decent, honest guy. I have a relationship of trust with my doctor, and I know he won't be offended by it."
Pare said he found an expensive double billing on his mother-in-law's hospital statement five years ago and informed the hospital staff. "I was glad to do it. Those things add up," he said.
Richard Wade, senior adviser for communications at the American Hospital Association, said AARP members will find enormously complicated bills that sometimes contain mistakes. "Fraud and abuse certainly raise everybody's hackles," he said. "But the vast majority of doctors and hospitals are honest and are just trying to work through this cockamamie billing system of ours. Clearly there is some fraud out there. And there is some value in what the AARP is doing. But it's not going to solve the fraud problem."
