Thursday, December 4, 2014


New Medicare Rules Aim to Reduce Abuse (Wall Street Journal, December 4, 2014, page A6,) []

You need to read articles such as this to understand how confused, incomprehensible and unresponsive our Progressive-directed federal government really is.

I remember that a few years ago there were around 175,000 (one-hundred seventy-five thousand) pages of Medicare rules and regulations, and that at any particular time anyone -- anyone -- touching it could be found in violation of something.  Physicians, providers, institutions, patients, advisers, consultants, anyone except politicians apparently.

This article states that last year "Medicare issued $45.8 billion in IMPROPER PAYMENTS (forty-five billion, eight-hundred million dollars, $45,800,000,000)! THIRTEEN PERCENT OF ITS TOTAL SPENDING! (13%!) That calculates to $261,714 per page of laws, rules and regulations every year that is "improper."

Medicare cuts checks first, asks questions later. If something seems awry, the feds "undertake lengthy, expensive audits and claims reviews" then go after the possible perpetrator.  Mostly doctors, it seems, because they do the expensive billing.

President Barack (Obamacare) Obama newly dictated a "significant shift in how the government tackles waste in Medicare..." One rational human being might think that would consist of a review at the heart of the 175,000 pages to see why the greedy physicians cheat the system and how they get do it. BUT NO! The president's brilliant idea is TO ADD MORE PAGES OF RULES AND REGULATIONS (since he can't pass laws!)

NOW, apparently the Centers of Medicare and Medicaid Services (CMS) can revoke the ability to bill of any doctor, medical equipment seller or any one else.  He, she or it must demonstrate a pattern -- and I am sure that term is exquisitely defined down to the placement of each dot and cross of each "t". If that "pattern" of billing is "inappropriate" as someone perhaps arbitrarily decides, or much more likely there had been article or feature in the media highlighting something some reporter deemed "inappropriate" then PRESTOCHANGO the targeted person or company will not get paid or able to bill Medicare. The Journal article then calls Medicare/Medicaid "a bureaucracy that historically has been slow to move and susceptible at times to POLITICAL PRESSURE." (Those capital letters were my doing.) No duh!

CSM can make such a revocation in the clear-cut case of suspected abuse, and I must say that is an arbitrary arbitrariness. If I work at CMS and I don't like some doctor (maybe he cheated with my wife) or company (it makes a profit), I can say I suspect something and I can bankrupt the provider. Does that seem "clear-cut?" It sounds like a clear-cut unconstitutional process. The person is guilty if only suspected.  SUSPECTED? GUILTY?

In the Obama administration assertions and suspecting is tantamount to guilty with the typical media coverage.  Banks, for example, have paid out tens of billions of dollars in fines with never being able to go to court. That seems to be the Progressive view of "fair."

Another contradictory issue.  The Obama administration is generally attempting to prohibit the use of criminal records in credit and hiring decisions.  But here in his CMS-land, providers cannot get into the MedicareMedicaid program if "they have had certain felony convictions." Contradictory or hypocritical, you decide.

The entire healthcare industry -- America's largest -- is the most expensive in the universe because of so much micromanagement of it by the government.  Providers must devote gigantic sums to get round the burdensome and incomprehensible rules in order to stay in business.

TRUST is at the core.  LiberalProgressiveDemocrats do not trust "We the People" and capitalism, so barriers must be erected to stop honest, hard-working healthcare workers from cheating.  As with every group of human beings, using the bell-shaped curve, some percentage of that group can be dishonest, but by far the greatest number never will be.  Democrats regulate as if all Americans are crooks.  It is unnecessary and expensive.

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