Medicare Audits – Or How I Spent Part of Labor Day Weekend

Copyright 2105 Daniel Ginsberg PhotographySome weekends I go to my office to try and catch up on paperwork. This Labor Day weekend I had to ‘labor’ away part of it to satisfy a Medicare requirement.

I received a fax from a medical supplier saying that Medicare had sent them an, “additional documentation request” for diabetic supplies for a patient of mine from June 2013. I didn’t see her on the date of service they listed, nor even see that I prescribed any diabetic testing supplies then, though it’s possible I filed out a faxed form and it wasn’t saved to her chart.

They requested that I include copies of the patient’s blood glucose testing logs. I do not routinely scan those into the chart, so I don’t know how that’s supposed to happen.

They also say to verify that the records contain the following other items, though it could be considered fraud to go back and add them now:

  • Patient’s Diagnosis and Prognosis
  • Patient’s Testing Frequency
  • Condition and Treatment History
  • Quantity and Day Supply Prescribed
  • Physical Limitations Due to Condition
  • A1c Lab Report
  • Insulin/Non-insulin
  • Insulin Injections/Pump
  • Medication lists

In addition, they want all documentation from 6 months before the service date up to the present day, and they want it, “ASAP.” That’s 2 years and 9 months of documentation, all for a few diabetic test strips I prescribed (which I don’t make any money from, for the record)!

What’s more, it says that we are not allowed to charge the supplier or the beneficiary (the patient) for providing this information.

That’s your government, hard at putting us primary care doctors to work.

Author: Daniel Ginsberg, MD, FACP

I'm an internal medicine physician and have avidly applied computers to medicine since 1986, when I wrote my first medically oriented computer programs. So yes, that means I'm at least 35-years-old!

4 thoughts on “Medicare Audits – Or How I Spent Part of Labor Day Weekend”

  1. Sometimes “reform”, whether in Medicare or other government agencies, is better served with less regulations that are more streamlined, efficient, and yes, involve less government involvement and less government workers, provided those workers who remain or who are recruited, are some of the best in their field. Some would say that in order to achieve this kind of “reform”, the reform would need to allow government to pay for the very best they hire; well above current salary guidelines, so as to attract those from the private sector already earning such compensation. This entails removing the philosophy of public servant compensation limitations and creating a free market for government hires. The “reform” would allow such employees who head departments to hold themselves and their agencies accountable for not only efficient and effective employee production, but also for enforcement of the new and efficient regulations in a fair and pragmatic manner (ie., where action results in the most benefit and/or cost savings) including the approach to Medicare fraud. Most important, such “reforms”, in order to be implemented and continue in effective resolve, need to reform how government employees who are not performing to acceptable standards (a current and past problem of substantial waste) may be terminated. For some reason, the “public servant” doctrine seems to have created extra protections and many regulatory hurdles to fire a government employee (again at large taxpayer expense). Short of substantial civil or criminal activity, it is practically impossible to terminate a government employee for clear proven repeated failure in job description performance, something that does not exist in the private sector. Ultimately, in my opinion, such “reforms” for streamlining government programs that have long been of the inefficient, ineffective, wasteful and costly status to taxpayers and that would never survive in a private sector of accountability, will need to come about by political and congressional acts and we know how much success that has had in the last 8 years, and Federal Congressmen and Congresswomen should have term limits considering their public servant rewards, so that these “reforms” can happen. Term limits gives such politicians an incentive to “get stuff done” while serving our country, improves the chances for bipartisan success to get it done, and a job well done may very well serve them nicely in getting hired back in the private sector. Of course, one more “reform”; can someone explain why a Federal senator or house representative should be “entitled” to a full salary pension for life?

    1. In his TED talk about educating children, Sugata Mitra said, “Imagine trying to run the show, trying to run the entire planet, without computers, without telephones, with data handwritten on pieces of paper, and traveling by ships. But the Victorians actually did it. What they did was amazing. They created a global computer made up of people. It’s still with us today. It’s called the bureaucratic administrative machine.”

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