By Jane M. Orient, M.D.,
My
reason for not accepting government money is a letter dated Feb 4,
1974, the year I graduated from medical school. My father, who owned a
small contracting business, thumb-tacked it over his desk, to remind
him not to bid on government jobs.
The letter from Russ Plumbing Company, one of his best subcontractors, reads as follows:
“According
to your government, the powers that be have decided that we have
exceeded our allowable profits in 1972 at the rate of 1/13th of 1%.
“Consequently,
we have consented, under the Voluntary Compliance Agreement, to
reimburse a total of $789, the amount involved, to our 1972
Contractors. We have endeavored to prorate this amount as equitably as
possible.
“May
we take this opportunity to mention that although we have shown a net
loss for the fiscal year 1973, it does not have any bearing on the
above decision.
“Enclosed herewith please find a check to cover the amount due you.”
A check for $17.90, which my father never cashed, was attached.
Russ
had been the low bidder on a government job—which he finished
satisfactorily, on time, for the agreed-upon price. Things went
unusually well, so he made more profit than expected. The government
decided that he had made too much, and not only demanded a refund but
also decided to audit all his private contracts. Auditors swarmed over
his office. Productive work was shut down. Russ, who was a good
plumber, a hard worker, and a decent, honest man, was ruined.
Where
did the government get the authority to pass judgment on how much
profit a plumber was allowed to earn? Apparently, it just assumed the
power and proceeded to exercise it.
I
posted a copy of Russ’s letter on my wall also, and never accepted a
government check after I stopped working for the Veterans
Administration and went into private practice. Until 1990, many of my
patients filed their own Medicare claims. Since then, the doctor has
had to file the claims, even if they are “unassigned” so that the
patient receives the check. His signature on the claim means that the
doctor agrees to abide by all the rules, of which there are more than
100,000 pages. These include coding requirements and price controls.
Russ
got off easy. If a doctor gets overpaid, even through unintentional
error, he may have to refund three times the amount, plus pay a civil
monetary penalty. That used to be $10,000 per item, recently increased
to $11,000, and in the new law to $50,000. Then there can be serious
prison time.
As
executive director of AAPS, I have met an office manager who spent one
year in a county jail over the definition of—“office visit.” I have
talked to doctors whose office or home was invaded by a SWAT team that
pointed guns at patients or terrified children. One doctor’s home was
ransacked by government agents searching for medical records in
shoeboxes. Doctors have spent years in prison, with murderers, over
disputes involving less than 1% of their billings. At least half a
dozen have attempted or committed suicide after their lives were torn
apart by “fraud” prosecutions. These were real doctors, who worked long
hours caring for seriously sick patients. Their families are
impoverished too—bank accounts, houses, cars, retirement accounts all
seized. A few dollars from an “unnecessary” treatment could taint all
assets and subject them to forfeiture.
Most
doctors still think this only happens to “bad apples”—newspaper smears
help give that impression. Still, many doctors, instead of studying
about new treatments, are signing up for “compliance” courses to
minimize the damages from bounty-hunting auditors.
When
doctors begin to understand that much of the projected half-trillion
dollars in Medicare “savings” is expected to come from assets
accumulated by doctors over decades of hard toil, we are likely to see
a mass exodus, especially of older doctors in solo practice, who seem
to be the prime targets.
With fewer doctors, there will be less work done, and thus more savings.
Russ was just a plumber, and he got flushed. What can doctors expect, now that they are public enemy #1?
Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons,has
been in solo practice of general internal medicine since 1981 and is a
clinical lecturer in medicine at the University of Arizona College of
Medicine. She received her undergraduate degrees in chemistry and
mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care,
published by Crown. She is the executive director of the Association of
American Physicians and Surgeons, a voice for patients’ and physicians’
independence since 1943. Complete curriculum vitae posted at www.drjaneorient.com. Additional information on health-related issues: www.aapsonline.org and www.takebackmedicine.com.
Dr. Orient’s position on Obama’s healthcare reform: “The
Obama plan will increase individual health insurance costs, and if the
federal government puts price controls on the premiums, the companies
will simply have to go out of business. Obama makes promises, but the
Plan will deliver higher costs, more hassles, fewer choices, less
innovation, and less patient care.”
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