Overbilling by Doctors and Hospitals Costs Medicare a Billion Dollars a Year

Tuesday, September 18, 2012

Medicare lost a billion dollars a year over the last decade due to overbilling by doctors and other medical professionals, according to an investigation by The Center for Public Integrity.


Medical groups used higher rates that added at least $11 billion for treating elderly Medicare patients over the 10-year period under examination. The biggest culprit in the problem, accounting for $6.6 billion, is a practice known as “upcoding.” Doctors and hospitals bill Medicare by applying a billing code to an office visit or a procedure. For example, a 99211 is a problem that requires five minutes or less of a doctor’s time and can be billed at about $20. A 99215, on the other hand, which is billed at about $140, refers to a problem that demands a complex decision and takes 40 minutes or more of doctor’s time. In upcoding, the doctors and hospitals bill for a visit or procedure that is higher than the one they performed, a violation that is difficult to monitor considering that Medicare deals with an average of one million billings a day.


In their defense, doctors said the fee hikes were justified because of the complexity of caring for seniors. They also told the Center for Public Integrity that some increases may have been a result of corrections to years of under-billing for these patients.


Some counties have particularly bad records. Santa Rosa County in western Florida led the country with 60% of its billings being for the two most expensive Medicare codes. In second place, at 57%, was neighboring Escambia County, which includes the city of Pensacola.

-David Wallechinsky, Noel Brinkerhoff


To Learn More:

How Doctors and Hospitals Have Collected Billions in Questionable Medicare Fees (by Fred Schulte, Center for Public Integrity)


John Sanders 10 years ago
The biggest issue is the disparity of payments to different physicians. I am a primary care physician who spends time with his patients and have to borrow money every month to make payroll. While some physicians may get paid princely ammounts for endoscopies that take them 15 minutes, I get paid peanuts to treat a complex patient that may easily take an hour of work just with the patient. Not even taken into account the fact that I get phone calls from my patients at all hours of day and night including weekends and holidays. The payment to physicians should NOT be based on the number of minutes spent face to face with the patient but should include all the countless hours that one spends conferring with consultants, reviewing records and arguing with insurance companies. Physicians who have high paying specialties can hire any number of staff to deal with all the paperwork and myriad of administrative issues. Those of us who actually spend time with our patients and actually care for them, get paid next to nothing for the work and effort we put into our profession.
Carol Ellison 11 years ago
I just received a $3,000 bill for 2 visits to a new doctor. He did a couple of Ultrasounds, in the office, and a few other tests. I was SHOCKED at the $900 charges for an ultrasound that took only 10-15 minutes and had the equipment in his office. He did another on my corataid artery -- for what reason I do not know!! I came in for Stomach problems. He annouces he will do a FULL Workup!! NOT Necessary and I feel he has OVERBILLED! I am not going back and see that another doctor had billed $125 for a simple office visit that took less than 10 minutes!! It's Outrageous!! I will not be seeig a doctor for a long time -- May die of whatever, but they are sucking the life out of Medicare -- and we DO pay 20% -- of $3,000 - that more than I can afford a MOnth!!
john del grande 11 years ago
OverBilling by Ohio Valley Medical Center, 2000 eoff street, wheeling, wv 26003-3823, Dr Feder, Billed my insurance company 3 times for the exact same test 3 times within a 1 month period. 3 Bloodtests for testosterone, the exact same test ordered me to take it three times, now i am stuck with a huge BILL my insurance company will not pay. Just imagine what they are doing to the Government if this is happening to me.
anonymouse 11 years ago
Good news! Only a billion dollars per annum? That's the amount Bush wasted in Iraq every, what, two days? Another way to think of it: One billion dollars averaged over a total of 350 million claims per year = $3 overage per bill, correct? Less than the price of a hospital aspirin. Pretty remarkable record, I'd say.

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