Have you heard? The #1 alternative being presented by those pushing to repeal the entire Affordable Care Act (vote #33 and counting ) is stripping injured patients of their legal rights. It’s with this in mind that we mention the front page New York Times story today about an incredible scam doctors are running to line their pockets and rip off health insurers – let alone patients. And it all sounds way too familiar to us. Let’s explain. First, here’s what the Times found:
At a time of soaring health care bills, experts say that doctors, middlemen and drug distributors are adding hundreds of millions of dollars annually to the costs borne by taxpayers, insurance companies and employers through the practice of physician dispensing.
Most common among physicians who treat injured workers, it is a twist on a typical doctor’s visit. Instead of sending patients to drugstores to get prescriptions filled, doctors dispense the drugs in their offices to patients, with the bills going to insurers. Doctors can make tens of thousands of dollars a year operating their own in-office pharmacies. The practice has become so profitable that private equity firms are buying stakes in the businesses, and political lobbying over the issue is fierce.
Doctor dispensing can be convenient for patients. But rules in many states governing workers’ compensation insurance contain loopholes that allow doctors to sell the drugs at huge markups. Profits from the sales are shared by doctors, middlemen who help physicians start in-office pharmacies and drug distributors who repackage medications for office sale.
“I consider the fees that these people are charging to be immoral,” said Alan Hays, a Republican state senator in Florida who introduced a bill to bar physicians from dispensing pills that was defeated. “They’re legal under the current law, but they’re immoral.”
Just as immoral – if not fraudulent - is the pervasive practice of doctors prescribing expensive, unnecessary, and sometimes even dangerous tests - again, using their own offices to line their own pockets. For example, in a Washington Post article we found a few years ago, doctors at a medical clinic on the Iowa-Illinois border were ordering eight or nine CT scans a month in August and September of 2005 until they bought their own CT scanner. Within seven months, those numbers ballooned by 700 percent. And there are many other examples.
Meanwhile, what do the health care act “repealers” call the practice of ordering unnecessary tests? They call it “defensive medicine.” But we call it fraud. So does the government. Doctors who bill Medicare or Medicaid for tests and procedures done for personal purposes as opposed to what are medically necessary for patients, are committing fraud under federal and state Medicare/Medicaid programs.
When people engage in insider trading to protect themselves from loss, they get prosecuted. When doctors bill for unnecessary testing or treatment, which they claim are solely to protect themselves, they get Members of Congress to defend them, blame patients for their fraudulent behavior, and then get laws passed to take away patients’ rights. Which, of course, has no impact whatsoever on doctors who are in the practice of ordering unnecessary tests. What's wrong with this picture?