Medicare health care costs have been rising drastically for years. We’ve known for years that Medicare spending was getting out-of-hand, but one of the reasons for the rising spending could have little to do with Medicare and more to do with the hospitals. Let us answers what questions you have concerning some Medicare myths you have heard before making a decision on your health care.
According to a recent Federal report, 21 different hospitals overcharged Medicare for services and treatments. The report came out of the U.S. Department of Health and Human Services last month. Some state hospitals were listed as over-billing by almost 20%. “Overcharging” is the idea of billing Medicare over the nation’s average for the same services.
Leading the pack of the “over-billers” is Louisiana, which was reported to be charging as much as 19.4% over the estimated value. Texas comes in a close second with an average 17.3%. Rounding out the rest of the top 5 states were North Dakota, Wyoming, and Georgia. All of these had hospitals that were charging a significant amount more than what Medicare thought was appropriate.
While the idea of hospitals overcharging isn’t new, and Medicare professionals have known that some hospitals were charging more than averages, several Medicare experts are still surprised at the report’s results. “This shocking list shows that it is not just one or two states that are responsible for the high average of improper payments nationwide, but, in fact, overbilling is rampant across the country,” said Kristin Walter from the Council of Medicare Integrity.
So, how much did all these states over billing cost Medicare? An estimated $43.4 billion dollars was overpaid to hospitals, nursing home, physicians, and more during 2015. Yes, you read that right, $43 BILLION. Those $43 billion doesn’t even account for the costs of Medicare fraud. In 2014, the Government Accountability Office estimated that America lost around $60 billion through Medicare fraud, abuse, and false payments.
While it might seem like every doctor and hospital is overcharging to pad his or her own pockets that might not necessarily be true. Health care experts think that some of the waste could be mistakes or confusion on the billing process. The U.S. medical coding system was recently experienced a drastic change, the first on in over 35 years. With the new system, there are 69,000 different codes for ailments, conditions, and health complications. Compare this to the 14,000 different codes from the previous coding system. Some health administrators are still experiencing problems adjusting to the new system, which is thought is leading to some of the billing problems.
Regardless of how it’s happening, the wasted money is hurting everyone. These accidental (or purposeful) overcharges are costing Medicare more money, which trickles down to the enrollees in the form of higher premiums. The wasted money is funds that could be used for patients that need the money. These funds are also one of the main reasons that Medicare spending has seen such a significant increase in the past few years. If the trend continues, Medicare could see problems staying afloat in the health care market, which could have drastic implications for Medicare enrollees that depend on the program.
As Medicare continues to change and evolve, there are hopes that they will be able to eliminate some of the fraud, waste, and unnecessary expenses that are being used in the health care program. If they can eliminate the vast majority of the rising costs, they can then lower the costs of health care for everyone enrolled.
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