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Fraud and Anonymity: The Perils of Medical Care Bureaucracy

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October 8th, 2019   For Immediate Release

Contributor & author: Marilyn M. Singleton, MD, JD, (Oakland-California) board-certified anesthesiologist and President of Association of American Physicians and Surgeons (see bio at bottom of release)

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Preview:

  • After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance
  • Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments.
  • One amoral scheme recruits patients who unknowingly forgo curative treatment options by joining hospice.
  • In 2016 the government paid $160.8 million for drugs that hospice organizations should have paid for from its fixed daily fee. Our tax dollars paid for the drugs twice.
  • One typical victory is a Medicare patient whose neurologist prescribed a drug for his Parkinson’s disease symptoms. The government demanded testing that could not be done because of the patients debilitated condition. Despite a sympathetic ear and supporting research, the government arbiter could only parrot the party line: because the drug was not on the “list,” it was not covered by Medicare. In a fortunate twist of fate, with a Good Rx coupon the patient paid $34 per month cash instead of the drug’s $1,100 per month price with 20 percent patient co-pay that would have been charged through the Medicare Prescription Drug program.

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The high cost of medical care is on the lips of every politician and draining the pocketbooks of most Americans. After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance. Piling on more laws, regulations, and agencies is not the answer.

Anonymity, complexity, and opacity invite shady behavior. Individuals, companies, and patients who defraud the massive federal “health system” would never dream of lifting money from their patients’ wallets or stealing from their doctors’ cash drawer.

The government’s track record does not bode well for imposing more bureaucracy to remedy a problem created by the layers of third-party payer bureaucracy. Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments. By contrast the typical private business loses 5 percent of its revenues to fraud. Unfortunately, since its inception in March 2007, the Medicare Strike Force has recouped less than $2 billion per year in misappropriated funds. More

Congress Should Prioritize Healing, Not Hypocrisy

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May 1st, 2019

by Marilyn M. Singleton, MD, JD

 

Preview:

  • May is Mental Health Month and it should inspire us to think about family, community relationships, and our growing disconnectedness. It is not an invitation for Congress and other troublemakers to lose their collective minds.
  • Instead of looking for reasons to tear us apart, our congresspersons should be focusing on proposals trying to move us in a positive direction. Who cares what side of the aisle originated the ideas? Communities and their legislators must find solutions for hypodermic needles and human feces on the streets, the homeless, and drug addiction to name a few. There are 130 people a day dying from opiate overdoses with no easy answer as to the root cause. The Department of Health and Human Services formed a Pain Management Best Practices Inter-Agency Task Force including physicians and other professionals involved in caring for patients with pain and addiction issues. The task force concluded what most physicians already know: patient care must be individualized.
  • Save for a few rotten apples, physicians are doing their best to care for patients with complex problems. Mental Health Month offers physicians the opportunity to reaffirm that we are not automatons and patients are individuals, not data points. Congresspersons should take this month to stop squabbling and jockeying for power and explore legislation that allows physicians and patients freedom to choose their own path to a healthy life.

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May is Mental Health Month and it should inspire us to think about family, community relationships, and our growing disconnectedness. It is not an invitation for Congress and other troublemakers to lose their collective minds.

While folks of all colors and lifestyles are quietly living and working together and building relationships, the professional malcontents are looking for offense around every corner. Take the sports teams shunning Presidential Medal of Freedom recipient Kate Smith for having performed some songs with racially offensive lyrics in the 1930s. One of the songs, thought to be satirical, was also sung by black actor and well-known civil rights activist, Paul Robeson. Apparently, no one looked into Smith’s motives or other aspects of her life before shrouding her statue in black. How ironic that the very teams that excluded black players are “virtue signaling” at someone else’s expense.

Will the memorials to the progressive icons Eleanor and Franklin Roosevelt suffer the same fate? Historians note that Mrs. Roosevelt called black folks “darkies” and “pickaninnies.” Yet she was instrumental in having black opera singer Marian Anderson perform in an integrated setting and flew in an aircraft piloted by a Tuskegee Airman, among other things. More

Doctor Robot for You, Real Doctor for Me

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Contributor & author: Marilyn M. Singleton, MD, JD, (California) board-certified anesthesiologist and President of Association of American Physicians and Surgeons  (see bio at bottom of release)

Interview – Contact booking at dr.marilynsingleton@gmail.com, or call Dr. Singleton directly at 510-421-5800

 

Preview:  Medical technological aids have now jumped the shark. An unbelievable, but—thanks to cell phone video—verifiably true news report detailed how a robot rolled into a patient’s Intensive Care Unit cubicle and a physician’s talking head appeared on the robot’s “face” and told the patient the sad news that he had a terminal illness. While remote medicine is reasonable in rural areas where access to medical care is limited, telling a patient he is going to die from a TV screen is a crime against all medical ethical principles.

  We can certainly expect more medicine by proxy as larger corporations and the government takes more control of our medical care

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March 19th, 2019

Doctor Robot for You, Real Doctor for Me

by Marilyn M. Singleton, MD, JDl

A couple of years ago, computer programs, algorithms, and glorified Google searches were touted as the replacements for a physician’s analysis of a patient’s medical condition. Compressed medical research is quite useful for clinicians who are presented with novel situations and have no readily available colleagues with whom to discuss the case. However, the purpose of flow charts should not be to replace the brains of busy clinicians or, worse yet, be a cookbook for the practitioners at drugstore clinics.

Medical technological aids have now jumped the shark. An unbelievable, but—thanks to cell phone video—verifiably true news report detailed how a robot rolled into a patient’s Intensive Care Unit cubicle and a physician’s talking head appeared on the robot’s “face” and told the patient the sad news that he had a terminal illness. While remote medicine is reasonable in rural areas where access to medical care is limited, telling a patient he is going to die from a TV screen is a crime against all medical ethical principles. More

New Years Wish: No More Morally Superior Phonies

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by Marilyn M. Singleton, MD, JD

Preview: 

  • My new year’s resolution is to expose the hypocrisy of the morally superior politicians whose election strategy was to pretend they cared about crafting policies in the country’s best interest.
  • Multimillionaire Nancy (“We have to pass the bill to find out what’s in it” and if you disagree with me you are sexist) Pelosi is safe in her Napa Wine Country or San Francisco home, far from the drug addicts, dirty needles, feces, gang members and homeless lining the streets of San Francisco. Her voters may be too uninformed or willfully blind to see what she and her ilk have done to this formerly beautiful city. Sadly, the nation will be forced to suffer from her policies that reward scofflaws, patronize the poor, create dependency, and are designed to hustle votes.
  • Because their lives are so much more precious than ours, the power brokers have their private security and the medical care of their choice. They also have no shame.

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January 15th, 2019

My new year’s resolution is to expose the hypocrisy of the morally superior politicians whose election strategy was to pretend they cared about crafting policies in the country’s best interest.

Take “the wall” on our southern border. Ignoring the opinion of the border patrol agents (51 percent of whom are Hispanic) that it would “without a doubt” be a helpful tool, Nancy Pelosi and her people claimed it would be ineffective in stopping everybody. That’s like the Centers for Disease Control and Prevention (CDC) stopping its flu vaccination campaign because the vaccine is only 40-60 percent effective.

And sanctuary state California Senator Kamala Harris was quick to the gun control microphone when some people were shot in a brawl but not a peep out of her when a community is in mourning after its brown-skinned legal immigrant policeman is gunned down at a traffic stop by a twice arrested illegal immigrant. More

Warning: Government Can Be Harmful to Your Health

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Marilyn M. Singleton, MD, JD., http://www.aapsonline.org/

“In 1989, a Centers for Disease Control and Prevention (CDC)-sponsored study tested an experimental measles vaccine on 1,500 six-month old Black and Hispanic babies in Los Angeles. The CDC admitted in 1996 that parents were never informed that the vaccine was experimental.”

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Trust in our government was a mere 19 percent in 2013 according to Pew Research Center. Not surprisingly, 56 per cent of Americans think it is not the government’s responsibility to provide a healthcare system. Waivers, favors, off-the-cuff rule changes, and the bungled launch of the Affordable Care Act website validate that distrust.  Bureaucratic incompetence and cronyism are not the only reasons we should be wary of government involvement in our medical care.

The federal government has a checkered history when it comes to medical judgments. We now cringe at the words of the revered Supreme Court Justice Oliver Wendell Holmes in the 1927 case, Buck v Bell upholding Virginia’s sterilization law for the institutionalized “feeble-minded.” “[Carrie Bell’s] welfare and that of society will be promoted by her sterilization. It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. . .Three generations of imbeciles are enough.” In fact, Carrie’s mother was a prostitute, but not feeble-minded. After Carrie’s release she maintained a job as a domestic worker and became an avid reader. Her “feeble-minded” daughter was on her school’s honor roll.

Let’s recall the appalling Tuskegee Syphilis Study lasting from 1932 to 1972.   The U.S. Public Health Service used 400 hundred mainly poor, illiterate black sharecroppers with syphilis as lab animals. They were told they had “bad blood,” but not that they were actually suffering from a serious but treatable disease. All subjects succumbed to untreated syphilis so our government could track the natural progression of the disease. More

The Emperor Has No Clue

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new-logo25By Marilyn M. Singleton, M.D., J.D.,

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When President Obama hawks the wonders of the misnamed  Patient Protection and Affordable Care Act, I’m reminded of those “As Seen on  TV” products.

True believers ridiculed critics of the Independent  Payment Advisory Board and its unchecked power to ration health care. They were  impressed by the $575 billion cut to Medicare, although lower payments lead  physicians to accept fewer Medicare patients. They cheered because 11 million  Americans will be added to the Medicaid rolls over the next ten years. While  Medicaid looks like is a good deal with its low co-pays, provider payments are  so low that only one-third of physicians accept new Medicaid  patients.

True believers scoffed at claims of loss of privacy.  After the NSA snooping revelations, a Pew survey revealed that 70 percent of  Americans believe the government is using data for purposes other than fighting  terrorism. Not only could unethical employees misuse health and financial  information, the health “Data Hub” can be shared among seven federal agencies  for ill-defined “routine uses.” According to a former HHS general counsel, the  federal government’s computer program for insurance exchanges lacks privacy  safeguards and could expose applicants to identity theft.

President Obama has repeatedly promised that “if you  like your health care plan, you can keep it.” Even his Praetorian Guard has now  defected. The National Treasury Employees Union—which represents the IRS folks  who are ultimately in charge of ObamaCare—does not want its members to be  “pushed out” of the Federal Employees Health Benefits Program and into the  insurance exchanges. More

The Medicare Free Wellness Visit: I’d Rather See a Veterinarian

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new-logo25By author/contributor Marilyn M. Singleton, M.D., J.D.

 Marilyn M. Singleton, MD, JD, (San Francisco) is a board-certified anesthesiologist, professor and Association of American Physicians and Surgeons member (see bio at bottom of release)

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“In fact, the free wellness visit is mainly a lost opportunity to discover conditions unknown to the patient and for patients and doctors to enhance their special relationship. It is, however, an opportunity for the government to collect data about the patient.”

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A friend went in for his Medicare free “wellness visit,” compliments of the Affordable Care Act (ACA). He assumed it was like a doctor’s annual check-up. After all, when he took his dog to the vet for a wellness visit, little Sparky was examined and tested for worms. So my friend made the mistake of asking the doctor to listen to his heart and lungs – just because that is what we expect physicians will do. Then he got a bill. Neither my friend nor his physician realized that if the patient was actually touched during the free wellness visit, it ceased to be free.

Medicare’s annual free wellness visit includes a review of medical and family history; making a list of current “providers” and prescriptions; measuring height, weight, body mass index, and blood pressure; and giving the patient a schedule and/or referrals for appropriate preventive services. The visit is “free”—the doctor must take “assignment” (be paid by Medicare, not by the patient) and waive the usual 20 percent “copayment.” The Medicare Part B deductible does not apply.

Physicians and a host of others, including “health educators,” can furnish the visit. Indeed, the California legislature is considering authorizing pharmacists and optometrists to serve as primary care providers. It is likely, since we are struggling with a shortage of physicians, that most offices have nursing assistants furnish the free wellness visit. Or if a physician in a smaller office with fewer personnel chooses to conduct the interview, he is relegated to the role of a scribe.

What patients need is an annual visit to be examined by a physician. They need a visit in which the physician can detect that new asymptomatic heart murmur or discover cancerous or pre-cancerous skin lesions. The Medicare Handbook makes it clear: Medicare does not cover routine physical examinations (average cost, $80 to $200).

Yet Medicare is willing to pay $155.89 for the free wellness visit. Perhaps a better investment would be a physical examination that would allow the patient and the doctor—not an office worker—to connect with one another. We all know the value of human contact for engendering trust in a relationship. Twenty minutes with the physician behind the computer doing data entry is not how most patients expect to spend their precious time during a medical visit. More

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