WILL CONGRESS CONTINUE A MEDICARE SCAM? Medicare paying insane rental prices for...

ncpa.org ^ | July 11, 2008

[InvisibleChurch]

This week Congress will demonstrate if it is serious or not about reining in entitlement spending, says Michael O. Leavitt, secretary of the Department of Health and Human Services (DHS).

Right now Medicare is paying insane rental prices for Durable Medical Equipment (DME) -- prices far higher than it would cost to purchase the equipment outright. DME prices are based on a fee-schedule established by law in the 1980s, not on competitive market prices. This is a price-fixing program, says Leavitt, and the equipment suppliers like it because they get overpaid and don't have to compete.

For example:

An oxygen concentrator costs about $600 on the open market. Medicare beneficiaries typically rent the machines for periods of up to 36 months at a cost of $7,142. The government, which pays 80 percent of the costs associated with items and services in Medicare Part B, pays $5,714 -- almost 10 times the free-market price of purchasing a concentrator outright. The patient pays $1,428 -- more than twice the free-market price of purchase. In light of this, when Congress passed the Medicare Modernization Act in 2003, it included a section instituting competitive bidding for DME, starting in selected communities. Unsurprisingly, the bids came in substantially below what Medicare pays -- on average 26 percent below. These new prices took effect on July 1, benefiting taxpayers and patients.

But those who benefit from excessive fees in the current system are now in lobbying overdrive, as they stand to lose substantial business. In late June, House Democrats and many Republicans voted to delay the bidding program by a year and a half.

Make no mistake: "Delay" means "kill," says Leavitt. Killing this competitive-bidding program would cost taxpayers about $1 billion annually, while unjustly overcharging senior citizens, says Leavitt.

Source: Michael O. Leavitt, "Will Congress Continue a Medicare Scam?" Wall Street Journal, July 9, 2008.

For text:

http://online.wsj.com/article/SB121556116413437535.html

For more on Health Issues:

http://www.ncpa.org/sub/dpd/index.php?Article_Category=16

[InvisibleChurch]

[CDHart]

This article is accurate. Not only Medicare, but also private insurance companies, are being scammed on DME. I have an oxygen concentrator for COPD. My insurance company was being billed $200 monthly for the machine. When my husband's employer put a $1000 maximum on DME per year, I decided to buy my own rather than pay the $200 the home health co. was charging. I bought a top-of-the-line unit for $600. That was a real eye-opener.

Carolyn

[bluegirl]

It is not just rental equipment that is overpriced. My daughter got some knee braces a few months ago. The store she got them from is affiliated with a hospital. They charged $395 each for the braces. We looked them up online and found that we could get the exact same braces for $108.

I called the store and asked why they charged so much. I was told that it was because of Medicare/Medicaid. They break the components into various parts per Medicare codes and charge for each part separately. They acted like they had to do it that way.

[joe fonebone]

i use a cpap machine....i can buy the machine brand spankin new for 350.00....the medical supply house i got mine from billed the insurance company 1400.00

[goldstategop]

They talk a good game in Washington about making Medicare more cost-effective and responsive but they don't really mean it.

"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus

[dalebert]

Of courst it will continue. crookes are getting rich off it.

[Islander7]

“They acted like they had to do it that way. “

They do! MEDICARE determines how billing is done and what codes to use. Unbundling (that is what you are describing) is illegal.

The rental fees don’t tell the whole story. Equipment has to be SERVICED and maintained. There’s a heck of a lot of overhead involved in maintaining and servicing home equipment. There’s a heck of lot of EXPENSE involved in meeting MEDICARE, OHSA, AHA, state and other regulations to qualify as a MEDICARE provider.

If MEDICARE buys the equipment outright (many private insurance companies do.) who maintains it? Oxygen is critical for dependent patients. Who do they call when the equipment breaks in the middle of night?

I was in DME for 12 years. Believe me, it is a tough business requiring a 24/7 commitment.

[fatrat]

i can vouch for your post. a couple of years ago i bought my own CPAP for $560 rather than pay 25% of the $1300 they wanted to charge to military tri-care. i felt better about it even though it cost me more. i could buy the same machine right now for around $300

my first machine was a bipap and the government paid about 3K rent on it before buying it for about 2000 and then continued to pay rent on it for another several mos after they bought it. i wrote a letter to the fraud division of tri-care and they said that they would recoup the last few mos rent but i will bet they didn’t.

[camle]

my wife had a tens machine a few years back. she used it for abotu two years whilst it was being rented, then they offered it to them outright for about 100, we bought it. after it died, I went on-line and got a better unit for about 80.

but someone’s learning. she also uses a bone stimulator. same principle, different frequency, I guess. nice unit. after about a month, she was told not to bother returning it when done.

[EEDUDE]

I called the store and asked why they charged so much. I was told that it was because of Medicare/Medicaid. They break the components into various parts per Medicare codes and charge for each part separately. They acted like they had to do it that way. You speak the truth. But another factor in the cost of this is the massive layer of bureaucrats necessary to handle all the paperwork. We're paying to keep lots of them employed. My PCP will not file insurance claims because of the paperwork.... But he only charges $60.00 per office visit. It's a good trade off. Medicare and Medicaid are rampant with fraud and abuse, but some of it is legit. Bureaucrats write up procedures. It's job security.

[DustyMoment]

WILL CONGRESS CONTINUE A MEDICARE SCAM?

Do you REALLY have to ask!!??

[bluegirl]

MEDICARE determines how billing is done and what codes to use.

My daughter is covered by private insurance, not Medicare, but they still billed it that way.

[Islander7]

If your insurance paid the bill without a challenge, they have a serious employee problem. Also, the DME provider may have been challenged for over payment and adjustments made without you ever knowing about it.

Most insurance payors have set fees, just as MEDICARE does. The same equipment codes are used for billing purposes.

[FlyVet]

Not to mention the scam artists ripping off the system. There was an article on here about Medicaid fraud in Florida awhile back. Some clown sold the same piece of medical equipment something like 50 times before he was caught.

Just try to imagine the fraud monster in a nationalized health system.

[socialismisinsidious]

Socialized Medicine aka Universal Health Care PING LIST

FReepmail me if you want to be added to or removed from this ping list.

[socialismisinsidious]

They don’t have to mean it. The money isn’t theirs...it’s ours. It is easy to spend (not care about) other people’s money and as long as they can use the tax code to take unlimited amounts of our money then it doesn’t matter what things cost or how much fraud there is in the system all that matters is tax dollars to vote buy with.

[vpintheak]

PIGS AT THE TROUGH, AND THEY HAVE NO REASON TO CHANGE IT.