A Collection of Problems with the US Health Care System

Psychiatrist. Florida. Statement 10125.

Categories: Health Care Professional Statements
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State:: Florida

Occupation:: Psychiatrist

I have practiced psychiatry for more than 40 years and during that time I have cared for numerous patients covered by Medicare. I am now covered by Medicare myself. About two years ago my secretary discovered that all of my Medicare claims were being denied. Each month the company which manages Medicare in Florida had a different explanation for the denial but after correcting whatever they claimed was the problem the claims were denied again the next month. This went on for months until late 2009 when someone at the Medicare management company announced that my Medicare Provider Number had been canceled. The Medical Director later said it was because I had filed no claims in 15 consecutive months. In fact I had filed claims each of those months and each time my claims were denied. I was informed I would have to file a new application. I did and the application was “never received.” In April 2010 I again filed an application for a Medicare Provider number and by then part of the application was done online and only a few pages were printed out to complete manually and mail in. Those I sent certified mail and had proof of receipt. Two months later they contacted me to report that I had failed to write in the seven leading zeros on my checking account number on the electronic fund transfer agreement and even though I had had to include a voided blank check they could not enter them and I would have to fill out the EFT paperwork from scratch, not just add the seven leading zeros but fill out all of the remainder as well. I did so even though they were going to have to manually re-enter those seven leading zeros when they copied the numbers into their computer. A few weeks later they informed me that another problem had existed on the EFT paperwork that I had not been told of when I resubmitted it and I would have to resubmit it all over again. On top of that the form for the EFT had changed between April and June and if I could not come up with a blank copy of the earlier form I would have to resubmit the entire application, both the online and paper portions. Luckily I found a passable blank copy and resubmitted only the EFT and it was finally accepted and my Medicare Provider number was re-issued. That happened one week before my financial costs of maintaining an office without Medicare reimbursement for over a year prompted me to decide to retire. I had been assured through the process that once my number was reissued I could resubmit my claims and those that were not older than a year or so would be paid. Now I am told that I will be paid only for services provided since I regained my Medicare Provider number–by that time I had finished seeing my patients and was making referrals. This constitutes Medicare Fraud as far as I am concerned. Apparently a crooked physician is better prepared to cope with the corrupt Medicare system than the well-intentioned one who tries to provide top quality service to his/her patients. Finally, when I tried to find psychiatrists to whom I could transfer the care of my patients I discovered that no other private psychiatrists in the area would accept Medicare because they would not subject themselves to what I have gone through. This is a simplified version of what happened. In fact the problems I ran into in trying to regain my Medicare Provider number were so numerous and absolutely unbelievable you would have had to experience it. I have spoken to several colleagues who report similar horror stories. Yet no one is doing anything about this kind of Fraud against Medicare providers!