According to the Obama Administration, many doctors are unethically billing some Medicare users for deductibles, co-payments and other costs which they are exempted from paying. Federal officials have warned health professionals that they may be penalized if they continue with their unethical practices. The doctors could be fined or even excluded from Medicare services. The people who qualify for Medicare are 65 and older, or disabled and have generally low incomes, less than $1,000 for a single person or $1,355 for a married couple. These people also qualify for Medicaid, a social health care program for families and individuals with limited resources.
According to federal law, Medicare users do not have any legal basis to make any payment to a doctor, hospital or any medical facility other than which is covered by Medicaid and Medicare. The Obama, staff while talking to doctors, said, “Doctors must accept Medicare payment and Medicaid payment as payment in full for services rendered to a qualified Medicare beneficiary.” The Obama Administration expressed its concern over the unethical proceedings on a number of occasions.
Medicare is run by the federal government while Medicaid is jointly managed by the federal government and state governments. Details such as eligibility criteria, payment rates and patient benefits vary from state to state. At the moment there are 7 million deserving low income individuals who receive financial aid through Medicare. State Medicaid agencies have to pay for all Medicare expenses, but do not have to pay the full cost of expenses to doctors, and in some cases pay nothing at all, leaving the doctors with hundreds or even thousands of dollars’ worth of expenses.
In the doctors’ defense, though, many do not know whether a patient qualifies for Medicare which makes managing finances complicated. The government needs to train doctors and health administration staff over the legal procedures and latest Medicare and Medicaid rules and regulations to avoid a messy situation such as this in the future.