Into the Labyrinth

Editor's Note: This sidebar is part of " The Problem with ObamaCare ."

June 2009 --I first met Dr. Alieta Eck at the Zarephath Health Center in New Jersey, a clinic she opened   with her physician-husband John in 2003 to provide free primary care to poor patients who do not have private insurance or access to government programs like Medicare.

Dr. Eck also has a private practice where she treats Medicare patients. She "balance bills" these Medicare patients, meaning she charges an extra 15 percent above what Medicate pays her, and the patients have to pay the full charge before being reimbursed by Medicare. If a doctor doesn't balance bill, then the paitent enver sees the full charge.

A Ron Paul supporter, Dr. Eck’s libertarian leanings explain why she balance bills.  “Financially, I don’t need it,” Dr. Eck said.  “I like to have patients between me and the government.  The patients know exactly what I’m billing for.  It keeps everybody honest.”

An internist in private practice since 1988, Dr. Eck has only one major problem.

“Medicare is telling me that I charged my patients too much but is not telling me which patients I allegedly overcharged,” she said.

In late August, Dr. Eck received a letter from National Government Services (NGS)—the company that processes claims for Medicare in New Jersey—telling her that she had made “charges that exceed the Medicare charge limit by at least $1.00.” The letter stated that if Eck believed that NGS was in error, she could appeal. If the appeal was denied, she “must refund to the beneficiary or adjust the excess amount within 30 days.” For information on the patients she had supposedly overcharged, the letter instructed her to “please review the report” that was enclosed.

“I did not get a report,” Dr. Eck said. “I just received the letter.”

"The bureaucracy can't guage performance in any meaningful way."

-Dr. Aleita Eck

Dr. Eck’s predicament is one that is all too common among physicians. Hassles from government health-care bureaucracy come in many forms, but they all have one main goal: to dictate the relationship between doctor and patient. They also have many unintended consequences, including requiring physicians to waste time and money, and diminishing the quality of health care patients receive. Such bureaucratic intervention can even be harmful to patients.

 I first met Dr. Alieta Eck at the Zarephath Health Center in New Jersey, a clinic she opened   with her physician-husband John in 2003 to provide free primary care to poor patients who do not have private insurance or access to government programs like Medicare.

Dr. Eck also has a private practice where she treats Medicare patients. She "balance bills" these Medicare patients, meaning she charges an extra 15 percent above what Medicate pays her, and the patients have to pay the full charge before being reimbursed by Medicare. If a doctor doesn't balance bill, then the paitent enver sees the full charge.

A Ron Paul supporter, Dr. Eck’s libertarian leanings explain why she balance bills.  “Financially, I don’t need it,” Dr. Eck said.  “I like to have patients between me and the government.  The patients know exactly what I’m billing for.  It keeps everybody honest.”

An internist in private practice since 1988, Dr. Eck has only one major problem.

“Medicare is telling me that I charged my patients too much but is not telling me which patients I allegedly overcharged,” she said.

In late August, Dr. Eck received a letter from National Government Services (NGS)—the company that processes claims for Medicare in New Jersey—telling her that she had made “charges that exceed the Medicare charge limit by at least $1.00.” The letter stated that if Eck believed that NGS was in error, she could appeal. If the appeal was denied, she “must refund to the beneficiary or adjust the excess amount within 30 days.” For information on the patients she had supposedly overcharged, the letter instructed her to “please review the report” that was enclosed.

“I did not get a report,” Dr. Eck said. “I just received the letter.”

Dr. Eck’s predicament is one that is all too common among physicians. Hassles from government health-care bureaucracy come in many forms, but they all have one main goal: to dictate the relationship between doctor and patient. They also have many unintended consequences, including requiring physicians to waste time and money, and diminishing the quality of health care patients receive. Such bureaucratic intervention can even be harmful to patients.

The largest federal health care bureaucracy is the Centers for Medicare and Medicare Services (CMS). CMS already has tremendous power over how much physicians can charge patients. It also has increasing influence over which procedures and how many procedures a physician can perform. CMS exercises its influence, in part, through the private companies that it contracts with to administer Medicare claims. Many of these are run by large insurance companies which, not surprisingly, have taken on many of the same bureaucratic qualities as CMS.

Dr. Eck’s office manager, Mariane, is well acquainted with those qualities. “Every time you call them [CMS], one department doesn’t know what the other department is doing.”

Mariane called the number listed on the letter that Dr. Eck received only to find that it had been disconnected. She then called the regional CMS office.

“They had no idea what this letter was referring to,” she said.

She then went through Dr. Eck’s past billing records, but could not find any instances in which they overcharged their patients. At that point, Dr. Eck decided to stop wasting time on the matter and just wait to see if she would receive another letter.

To find out why this happened to Dr. Eck, I called NGS and spoke to a claims service representative. She informed me that, due to privacy laws, she could only discuss the matter directly with Dr. Eck. I was then referred to CMS in Washington.  A phone call to them got me a pre-recorded message.  I left a voice mail.  When my call was returned, I was told to contact the regional CMS office in New Jersey.  That led me to another pre-recorded message.  I left another voice mail.  A few hours later, a CMS official at the regional office asked me to fax him Dr. Eck’s letter and email my questions.  After reading the letter, the CMS official emailed me back stating that he couldn’t process the complaint due to privacy laws.

I responded that I was not trying to get a complaint processed, and that I’d just like to know why Dr. Eck had received the letter. I also asked if any other doctors had had a similar problem. He replied that this issue was “national in scope”, that I should call the national CMS office, and that he wasn’t sure why the national office had referred me to him.

At this point my patience wore a little thin. I replied, “Is there anyone at your office who can explain why Dr. Eck received this letter?”

He stated that he could not help me, but instead referred me to the director of corporate media relations at WellPoint, Inc., the parent company of NGS.

A call to WellPoint did not get returned initially, but a follow-up email did. The gentleman at WellPoint informed me that he’d look into the matter. A few days later, he sent an email saying that Dr. Eck had received the “letter in error” and could disregard it.

Upon receiving this news, Dr. Eck was less than relieved. “How could that be an error? That letter was written by somebody.”

That letter can be traced back to the claims reform process. According to the NGS official who told Dr. Eck she could disregard the letter, “Our NGS division began transitioning the work they had been doing in New Jersey to a new enterprise data center.  During this particular transition, a system error occurred and these letters were sent to some providers in error.”

Dr. Eck had some parting thoughts about the proposed reforms of President Obama, Sen. Baucus, and other politicians who seek to expand CMS’s authority in order to “improve” the quality of treatment physicians provide.

“How does the bureaucracy gauge our performance? It assumes that the patient will do everything the doctor tells him to do, but what if he doesn’t? What if he doesn’t lose weight or quit smoking? Nor is the bureaucracy concerned about patient satisfaction, only if the physician followed the ‘right’ procedure. And in the end, clever doctors will still game the system to increase their revenue.”

“The fact is the bureaucracy can’t gauge performance in any meaningful way,” she concluded.

Indeed, it can barely answer phone calls and letters.

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