Medicare Works at Perfecting Obfuscation

When doctors contact Medicare carriers in the attempt to clarify Medicare regulations (so as to avoid inadvertently committing "fraud") they are left with incomplete responses, inaccurate answers, and other forms of obfuscation.  So says a General Accounting Office (GAO) report on Medicare communication with physicians.

The GAO report notes that the bulletins that Medicare carriers are required to send to doctors periodically are filled with dense, lengthy, and poorly organized prose - so as to make them virtually unreadable.  In many cases, even if they were readable it would have do little good - the bulletins routinely announce new regulatory requirements after the implementation date.  Call centers set up by Medicare carriers to answer doctors' questions fail to do so adequately 85% of the time.  Web sites (required by Medicare) to help doctors almost universally lack "logical organization and navigational tools," and as a consequence fail to meet the doctors' needs.

Tom Scully, the head of CMS (now the official acronym for what used to be known as Medicare,) acknowledged the truth of the GAO report, and said CMS would take steps to repair the problems "if it had the resources to do so."

DrRich comments:

DrRich does not blame the poor folks publishing bulletins, designing websites, or answering calls from angry and frustrated physicians for not making Medicare regulations clear.  The regulations (as we have pointed out elsewhere) are inherently unclear.  They constitute over 110,000 pages of dense, incomprehensible, self-contradictory prose that NOBODY can interpret as a coherent document.  While the regulations probably weren't made unclear on purpose (they just evolved that way) now that they are, they meet the needs of the feds quite nicely.

So when a doctor asks for instruction on how to comply with regulations (so as to avoid committing health care fraud - the latest federal crime - and incurring huge fines or jail time) nobody can really give him or her a straight answer.  For, while it's relatively easy to look at a doctor's actions after the fact and show clearly why those actions were in direct violation of one regulation or another, it is not so easy to tell the doctor how to avoid violating the regulation in the first place.  Besides, when the goal is to scare doctors into avoiding sticking their necks out for their patients, why would you want to give them a safe harbor for their actions? 

Somehow, DrRich thinks that even if more resources were made available to CMS, clarifying the regs for doctors might not be at the top of the priority list.  DrRich's guess is that more vigorous prosecution of regulation-violators would stand a better chance of soaking up such resources.

April, 2002

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