Just a “little” medical fraud

An elderly friend recounted this story to me. He’s upset. I’m upset. And I expect by the time we’re finished, the doctor will be more than a little upset, too.

Mr. Z is 90 years old, and except for macular degeneration which renders him mostly blind, he is very healthy and quite sharp. He lives by himself, but gets along and around quite well.

Last week, Mr. Z went to his podiatrist to get his toenails clipped, and when the doctor was finished, he exclaimed, “There you go, Mr. Z. Your corns are all taken care of.”

“Corns?” asked Mr. Z. “I didn’t have corns– all you did was clip my toenails.”

“Sure — you have corns!” Mr. Z was told. “Otherwise you’ll have to pay me out of your pocket!”

By the time Mr. Z returned to his apartment, he had figured out what it was all about. And he was upset. That’s why he told me the story. He realized the podiatrist was going to bill his insurance, or perhaps Medicare, for a procedure he didn’t really have. It made him mad.

Do you know who DID pay for that toenail clipping AKA corn repair? You did, and I did. Mr. Z surely didn’t pay for it, and the podiatrist probably made twice as much money on the transaction than he would have made had Mr. Z written a check. No doubt insurance and Medicare (maybe he billed them both!!??) pay more for corn repair than an individual pays for a toenail clipping.

As smart health and medical care consumers, we must be watchful when doctors and facilities get reimbursed for the work they do on us. If we were writing checks, or paying cash from our pockets, no doubt we would review billings carefully. But with insurance or Medicare as a middleman, it’s easy to let it go. That is one reason, of course, why insurance prices just continue to go up and up.

And when you find a discrepancy? Start by checking with the doctor or facility that was reimbursed. Give them a chance to explain it to you, or to change it.

If you feel they are trying to do something illegal, report it to the payor — your insurance company or Medicare. Here’s a link to the Medicare fraud reporting agency.

Do you want to pay for work that wasn’t done? Do you want to pay for everyone else’s healthcare? Does this make you as mad as it makes me?

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