Chronic Pain, the Loss of Civil Freedoms, Medical Fraud, a Patient Bill of Rights Part 1

The Loss of Civil Freedoms and Privacy

By R Carter

The war on opiates has seen sweeping changes on the rights and limits in which doctors can treat chronic and acute pain. Whether by intent or not the primary motivation has been fear, resulting in a disruption of healthcare with fines and penalties placed on prescribing physicians, sometimes in excess of $20,000 per incident. If deemed necessary, medical boards can suspend a prescriber’s license temporarily or indefinitely.

Using statues written for foreign drug traffickers, the DEA can confiscate business and personal property used in business, seize bank accounts and imprison targeted violators. They have powers that allow them to monitor web traffic on social medial, tap phone calls, email accounts and data mine other sources such as prescription drug monitoring programs, collecting information on both prescribers and patients.

And this is not the end; there are other planned efforts aimed at citizens through the use of social medial and other data sources to build cases for denying disability benefits.  And law enforcement continues to push for greater access to personal data on citizens all under the noble goal of putting an end to drug abuse. But it doesn’t stop there.

With Republicans planning a repeal of healthcare legislation, conservative goals would see those with preexisting conditions pay higher insurance premiums than those who can pay with cash or have relatively good health, transferring billions of dollars back into the hands of those who can afford the premiums. The end results would be a loss of healthcare coverage for millions who need it the most driving insurance rates even higher. So much for pooling costs and keeping them low for all American’s with a group policy.

As other efforts come to light the goals seem less like closing loopholes in the system and more like a super surge of conservative privilege which is designed to reduce the tax and cost burden on the wealthiest at the expense of those who are handicapped, elderly and impoverished.

The DEA and other law enforcement agencies have admitted failure and defeat in the war on drugs and because of an escalating overdose rate have turned to forming programs with public health officials targeting prescribers and patients in the belief that these rising death rates are due to prescribed drugs. At the same time public health officials, law enforcement and researchers admit there is no definitive data to support drawing such conclusions for prescription drugs used in chronic pain management, yet these facts go on ignored and the privacy rights of all citizens suffer, growing less in the last three years than at any other time in the history of this country. As a country we seem to be in reverse, making a mad dash back to pre-nineteen sixties civil liberties.

There are number of ways to reduce the cost of healthcare and close loopholes that don’t require cost shifting to the lower income brackets and middle class.

Medical Billing Fraud

As a former healthcare provider I recently reviewed EOB’s from a provider going back sixteen months and on each office visit I found at least one procedure billed where the service was not performed or a higher paying CPT code was used that didn’t apply to the services rendered. In some cases there were as many as three. I reported this to Medicare as fraud because being there, in the exam room; I knew which procedures had been performed and which hadn’t. Medicare’s solution, contact the provider revealing me as the complaint filer and request my records. After doing so the physician retaliated by discharging me from his practice with a one day advance notice. Thanks Medicare.

After Medicare reviewed the records they told me that the medical records matched the billing codes. Well of course they did, the clinic is not so stupid as to document one thing and bill for another. Still they closed the complaint and did nothing, and with this clinic seeing close to 600 patients a month and after speaking with other patients still going to the clinic, this provider continues this practice unabated.

When reviewing the EOB from the anesthesia provider and surgeon for a surgery done in January 2019, the surgeon billed correctly for a procedure on my elbow, the anesthesia provider did not, billing a higher paying CPT code on the shoulder, pocketing an additional $300.00 for doing so. Do that three or four times a day and you can add another $140,000.00 a year to your income and this is just one provider.

The healthcare system is ripe with this kind of fraud but the system has been so fined tuned to pay on demand that little effort is made to track down the fraud unless it’s a group practice doing this in mass for hundreds of millions of dollars. If you’re a lone provider operating by yourself, you can squeeze through the cracks unnoticed. Multiply that by 100,000 individual providers and assume just 1% are padding their fees in this manner and we’re talking $1.4 Billion dollars a year in fraud.

Why aren’t we going after this? I would be more than happy to pose as a patient, go into a clinic and verify that clinics bill for what they actually do. I guess Medicare has never considered this type of approach to fraud. For government, it makes more sense to go after those who can least afford medical care and squeeze them even harder.

In Part 2 I look at the recent history of trying to adopt into law a Patient Bill of Rights which would help protect us from the loss of civil freedoms and paying the cost of fraud.