Wednesday, November 14, 2012

Go to Hell, Medicare

     When Medicare has the barrel of a muzzle-loader aimed at your head, you've got to duck and hand over your wallet.  Or the keys to the whole store.  Either way, your life is messed up.
     But why does Medicare have a rifle pointed at me?
     I will probably never know.
     It's not enough to say, as a doctor--a perfect stranger--commenting about my blog, said:
     "A whistleblower reported you--and for nothing.  Why not?  There's no penalty.  Then, that gave Medicare carte blanche to stop paying you, and to 'take back' money in a maneuver one might consider sleight-of-hand except that it's completely legitimized within the system of rules invented by Medicare itself."
     That's not enough of an explanation, because we're a rational society, and we try to be fair.  Taking back money in this way is stealing.  A government that steals from its citizens is...well, committing suicide.
     I have initiated innumerable requests for information from Medicare, sending certified letters, making phone calls--curious, polite, insistent, or outright hostile (the clerks who answer never fail to maintain the exact same tepid tone, repeating their bromides robot-like, in a manner ingeniously designed to fuel homicidal rage in the inquirer)--sending faxes, recruiting my attorneys to make important get-something-done lawyer-phone calls, following Medicare's "procedures" for appealing unfair treatment.
     But there aren't any procedures.  The whole thing is a farce.  Medicare is an expert at avoidant behavior.  Medicare never answers questions outright.  It's criminal.
     Medicare is the criminal, not me.
     Yesterday I received, on my desk, a "response" from the despotic non-person we all refer to as Medicare--as though it really is someone, or something.  But Medicare is simply the stone-faced handmaiden for a rotten, bloated, self-important government.
     We are all participating--mostly in a passive way--in this government that is no longer of us, or for us, but acts against the interests of the people who pay for it--sometimes in vague or sidelong ways, at other times directly, with force, without defensible provocation, and causing nuclear-type destruction with fallout that is likely to take years to detect and measure.  The officials who administer government power seem to have separated themselves from the rest of us--as though they, with-incontestable clout,  applied when it suits them--are superior, constitutionally different, and entitled to everything we have, in fact, entitled to us, our very beings. 
     The aforementioned "response," was nothing more than a repetition of the same non-information Medicare sent before:  long lists of non-payments, supposedly for patients--whose names and other identifying information had been carefully eliminated from the document, and could, in fact, have been concocted by Medicare--with "explanations" (for not paying me) that were imprecise and speculative, but nonetheless immune to refutation:  "documentation insufficient, necessity of procedure uncertain, confusion about whether a shot should have been given or not, illegible signature, etc., etc."
     Needless to say, without the name of patients it was impossible for me to research each listed non-payment and send a rebuttal, in the form of proof that the procedure was necessary, and the documentation was sufficient.  (How much proof  is needed, anyway--for example, for flu shots, which we are instructed by Medicare to give its beneficiaries?  Sending documentation of each shot, along with the lot number and expiration date of the vial, and the patient, and the site, has not been enough--the hundreds of flu shots we gave last year have been denied for payment, repeatedly--therefore, I no longer purchase and give flue shots, which means my patients generally don't get them.  Now, isn't that saving a lot for Medicare?)
     The [bogus] explanatory letter stated, with no small grandeur, that a real, live Registered Nurse (capital letters used by Medicare, to underscore the impression of authority because such authority isn't real, and must be fabricated) reviewed the records we sent (thousands of pages, painstakingly copied by my staff and delivered, per Medicare rules, by snail mail--driven day after day to an official post office by my bookkeeper, who saves the receipts--records with handwriting documenting all the services we have provided over the past twenty-one months, during which scads of medical services were provided to fifteen-hundred-odd patients, services which often kept patients out of harm's way, or out of the hospital, services which, nevertheless, Medicare, in its great wisdom, has refused to pay for without "proof" that in fact I, a legitimate doctor, took care of actual patients who really wanted my help and needed the services I gave them)--this Registered Nurse, made the decision that my patient-care should be covered.
     Medicare's Registered Nurse instructed Medicare not to pay my office for 85% of my services, saying that in his/her opinion, those services weren't--weren't what?  
     I have no idea. I can't understand the cryptic messages encoded in thirty (?) pages of columns and not referable to any patients I know, which, as far as Medicare is concerned, makes it okay for this agency--which safeguards money my patients deposited over their working lives--not to pay me for the medical care my staff and I dispensed.
      Is it possible that the x-rays and EKG's and IV treatments for pneumonia, and last year's flu shots--were never done?  Or, at least in my office, are not justifiable?  Not documented clearly enough?  Were the patients not real?  Is my office not good enough?  Am I not a board-certified, licensed, credentialed, tax-paying, working physician?  
     Do I not exist??  What's going on, Medicare?  What do you think you're doing?
     Well, as it turns out, I can't argue with a Registered Nurse.  I'm not even allowed to know who it is.  And I can't fight with a motherboard.  There are no entry points in the armor Medicare uses to barricade itself from people like me, who want real answers in plain English.
     My patients, many of whom implore me--their long-time doctor--to stay in business, have no power, either--even though it's their money, contributed over their working lives, that Medicare is messing around with.
     Clearly, the decisions made between a doctor and patient about that patient's care are subordinate to the decisions made by a nurse in front of a computer in an office run on a nine-to-five schedule by Medicare.  Especially when Medicare's primary motive is not to pay.  It's going bankrupt, after all.  At least, that's what they say.
     Medicare, I'm kicking you out of my life.  You're a lying, cheating, embezzling monster.  I hope you fold up and die.
     To my patients, I say,  I can't take care of you as long as there's a muzzle-loader jammed up against  my brain.  I'm sorry.  I've tried, you know I have.


  1. How could a system in which a customer doesn't pay for the good and services they consume fail?