One test per year not related to a specific illness under Medicare? So much for preventive medicine.
In recent weeks we have been telling you about a new FDA proposal to increase its control over low-cost laboratory-developed tests—including locally performed custom diagnostics and tests for rare conditions. Tests like these are the future of medicine. People will soon be able to test for and spot cancers long before they manifest themselves using current methods. Testing can already help prevent diabetes, heart and blood vessel illness, prostate cancer, and other diseases.
Now for the bad news: Medicare will not pay for more than one test a year that is not directly related to the illness currently being treated by the doctor. In addition, Medicare rules forbid your doctor to treat (and therefore to test for) more than one ailment per office visit.
In theory, the patient could pay for the additional testing, but if those tests are deemed “medically unnecessary,” your doctor could go to jail for writing that prescription if he or she bills Medicare for the test. And if she or he wants to discuss the results of the test and prescribe a course of treatment, all discussion and treatment must be about that original ailment, even if you’re now sick with bronchitis instead.
It sounds absurd, but when claims for reimbursement are submitted for tests, procedures, or services that Medicare deems “medically unnecessary,” then they’re considered fraudulent “false claims” under the False Claims Act. In addition, what mainstream medicine deems “medically unnecessary” includes many natural treatments.
Yes, we know that doctors are sometimes involved in Medicare fraud, and it’s been growing: we reported on this issue back in 2010. However, it is more often a well-orchestrated ring of perpetrators committing organized theft. On the other hand, because of the complexity of Medicare rules, it is very easy to make a false claim. In one experiment, a researcher contacted five different government Medicare billing advisors about a possible claim and got five different answers about how to handle it. So even if a doctor stopped practicing and instead spent full time supervising each and every bill, the government can easily claim error and thus fraud.
To make it worse, checking with Medicare doesn’t protect the doctor. Even if a Medicare employee approved the billing, it can still be prosecuted. Of course, it isn’t that every error will be treated as fraud. It is just that it could be, and nobody is sure of what the rules really say. This is a very powerful weapon of intimidation and reprisal.
What about nutritional screening and counseling? Medicare will only cover medical nutrition therapy in very limited circumstances: if you have either diabetes or kidney disease, or have had a kidney transplant in last 36 months. (If you live in the Southwest, Medicare allows only one nutritional imbalance screening per year.)
If a product or diagnostic test is new, getting Medicare to create a new billing code for it can take a long time and cost doctors a significant amount of money in lost reimbursements. Even if there is already a billing code, Medicare must agree to pay for the service. In general, Medicare has not been willing to pay for genetic testing (except in screening for compatibility for kidney and bone marrow transplants), and it is certainly unwilling to cover the level of genetic testing needed to do truly personalized medicine.
Medicare keeps the focus on billable hours at the office from beginning to end. They won’t pay for physicians to consult with patients by email or over the phone—even if you’re old, disabled, or too ill to come to see the doc. They won’t pay for doctors to teach diabetics how to monitor their glucose levels or manage their diabetes in other ways. The same goes for other chronic illnesses.
In addition, Medicare requires the American Medical Association’s Current Procedural Terminology Codes (CPT), which healthcare professionals use to report medical procedures and services in patient records. Healthcare providers must use these codes—no other coding systems are permitted—in order to be reimbursed by Medicare. This squeezes out alternative medicine because there are no codes for many commonplace CAM treatments.
It is no coincidence that the coding monopoly is run by the American Medical Association and enforced by government. Fees earned from coding are believed to represent the bulk of AMA funding and make the AMA totally dependent on the goodwill of the Department of Health and Human Services.
Needless to say, Medicare only covers FDA-approved drugs—not supplements. The only fish oil Medicare will pay for is an expensive FDA-approved synthetic fish oil drug such as Lovaza. In theory, the FDA has only approved Lovaza for treatment of one condition. But nobody worries about that.
Is it any surprise, then, that Medicare is projected to be insolvent by 2026, only twelve years from now?
Government Puts Doctors in Stranglehold over Medical Testing and Diagnostics
One test per year not related to a specific illness under Medicare? So much for preventive medicine.
14 thoughts on “Government Puts Doctors in Stranglehold over Medical Testing and Diagnostics”
This story raises the hair on the back of my neck.
Of course it won’t get the attention of all those brilliant people who thought Obamacare was a good idea. Putting government in charge of health care was probably one of the worst things that has
ever happened to this country!
The government has no right to make decisions or withhold any diagnostics or drugs relative to my healthcare. I am solely responsible for my health. Vote socialized medicine and government control OUT OF OUR LIVES IN NOVEMBER 2014.
No change with Medical Nutrition Therapy. Medicare has historically only reimbursed for diabetes and kidney disease. No change.
Start researching. People today need to be in charge of their own health. Most tests are available independently. One can learn to read the results as well as or better than most doctors and find available treatment plans especially, and most importantly, nutritional plans. It would be sensible for at least one member of a family to learn to do minor surgery, stitches, tooth pulling, setting a simple fracture etc. Most medications can be purchased in advance of need out of the country. This course of endeavor can be much less expensive and certainly less frustrating then dealing with medical establishment as it exists today.
So is this any surprise? Obamacare, and thus its control over Medicare, Was passed into law without opportunity for review by legislators or media critics, so what did you expect?
Aren’t you glad you voted for the people who supported and endorsed the perpetrators of this corrupt and fraudulent power grab by the socialists? Many of us could see the chaos which these people planned for us. It’s happened before in history. It’s happening again and the results will be similarly tragic.
Medicare would never become insolvent if doctors were trained and allowed to practice preventive medicine and to prescribe natural supplements for nutritional deficiencies and other needs.
I need a corticosteroid in order to stay alive. However, I am allergic to the synthetic one that doctors prescribe. I therefore have to buy a natural one at $180 per month. Which means I cannot afford food. So I have to depend on the food bank, which rarely has the kind of food recommended for my health condition.
My doctor would love to be able to prescribe what I need, but she would lose her license if she did.
Can you say Rationed Health Care ? Who wants to push grandma over a cliff ? No death panels here. European health care is coming to America. All the things you were told about Obama Care are coming true. We were told the truth by those outside the administration and lied to by the administration.Is everyone catching yet ?
I read that about an average of $1,300.00 of cheating goes on by hospitals and care providers for each person who receives the care. This is mercenary.
Figures, it will go bust one year before I’m deemed old enough to be eligible….despite paying into the fund for decades. Talk about a ponzi scheme: I want my money back!
It’s also a penny-wise/pound-foolish policy that will directly affect my mom. Makes a lot more sense to address all your health issues in ONE visit rather than rack up the cost of multiple visits to the doctor. It’s also more efficient to address all your conditions if you can in one visit. Most people I know do not have just one health issue to deal with. Often, a health issue directly affects another one you have. For example: my allergies set off my asthma, which in turn raises my blood glucose (I’m pre-diabetic) due to the stress and also raises my blood pressure thus raising my eye pressure affecting my glaucoma. But addressing only the allergies by itself will not help address my other conditions fully.
Of course we can’t have anything resembling common sense in government now, can we?
I love your articles and petitions/comments to agencies, but please don’t lie about the solvency of Medicare. If Medicare did cover more tests and treatments, and reimbursed physicians at a reasonable rate, our care would cost more. I think those would be good changes, but we have to be willing to pay for them, as a society. There are a lot of problems with the system. Lets focus on fixing them, not condemning an important program to fail.
ObamaCare is already destined to fail. It was since it’s inception. It simply cannot survive with the sick paying the same amount as the healthy, and the healthy refusing to sign up and be extorted for that which they don’t want. The only way it will survive is to do just like Social Security, and threaten anyone with criminal penalties (kidnapping and caging) if they don’t comply. If ObamaCare was so great, no one would have to be threatened for it to work.
Dear Mr/Ms Moderator: This is the corrected version. Sorry for the omissions of the first submission.
Everyone has brought up so many points that it is hard to know where to start.
First–Obamacare was created by FIVE COMMITTEES and took over TWO YEARS to do so. And, from Obama’s tone when he asked if they were satisfied with it, he didn’t think much of it, either. So it is unjust to blame Obama when Congress messed around and stuck him with something that was NOT what he asked for, and that they all knewwas not right. Just recall that when President Kennedy and his personal physician announced on all 3 national TV broadcast systems that “Indian Tea” composed of 4 herbs had “cured” the physician’s own colon cancer with no other intervention–“not in remission but cured”, he said–and he added that he would be in his office at 7 am the next morning to tell the names of the 4 ingredients to anyone who phoned, the AMA poured millions (1960s value) into both houses of Congressthat same day, asking that they initiate a bill and pass it into law, with a quorum too large for Kennedy to veto, before 7 am the next morning–and both houses of Congress did just that, staying in session until 3 am or later to do so. The law made it a federal crime for anyone, even a doctor, to tell anyone, even his own patients, about anything tthat “cured” anything–or even just the ingredients in it. The radio commentators at the time had a field day over it. So JFK’s physician and JFK came back on TV the next day to explain that this had happened, and that the physician had been met (by 2 Secret Service men) at his office at 7 am the next morning, stating that they were there to arrest him if the doctor told anyone the ingredients in “Indian Tea” (now known as Essiac, with a human track record of 100% full permanent recovery for non-terminal cancers of all types, 98% full permanent recovery for terminal cancers of all types, and 100% full permanent recovery for terminal AIDS if taken for 5 years, 5 days a week on empty stomach).
Dr. William C. Douglass II several years ago wrote an article telling the same story (minus the type of cancer involved) about JFK’s doctor, Dr. Breusch, whom Dr. Douglass knew personally. Me, I just watched it unforld on national TV as a teenager. It hit me hard that the entire Congress wasn’t impeached. But we don’t have laws to cover our entire leadership going rotten. I read later that this event led to the anti-bribery laws for…
Obama still could have vetoed it if he wanted to. He would have had no idea if there would have been a quorum great enough to veto it, and even if so, isn’t it principled to veto something you disagree with? Obama is still to blame for this horrendous bill. He passed it.
This obviously excludes a wholistic, systemic approach to medicine. A sick body can manifest multiple symptoms, each requiring its own code, therefore it is a separate “diagnosis”. But to actually treat the real condition they would all have to be addressed in one form or another. Side effects on one treatment could theoretically be called a different problem by Medicare, leaving the doctor in a dilemma.