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Life Health > Health Insurance > Medicare Planning

Another governmental 'duh' moment

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Every successful marriage needs to have a spender and a saver. In our house, I am the spender, and my wife is the saver. Some may see this as running counter to stereotype, but without her, we would have been penniless a long time ago. Over the years, this arrangement has led to a few monthly rituals. The most longstanding one is the unfurling of the American Express bill to which I charge my business expenses.

Every month, bill in hand, she will wander into my office and ask me about any of the charges she can’t readily identify from the short description AMEX provides. Though this sometimes taxes my memory (and her patience), we agree that we should not pay any charges that aren’t ours or that aren’t correct. It just makes sense, doesn’t it?

Contrast this with the headline in last Friday’s issue of the Wall Street Journal, which proclaimed, “Medicare will start flagging suspicious claims — before they’re paid.”

What? They haven’t always done this? It turns out that, contrary to the private sector payers — you know, those characterized as evil and wasteful — Medicare has instead used a system known as “pay and chase.” They just pay charges as presented and review them retrospectively. If a bill shouldn’t have been paid, they chase it down for repayment.

In the third-party administrator universe, this kind of prior review has been standard operating procedure for as long as I can remember. Commercial insurers, credit card companies and others have also used prior review as the first line of defense in rooting out fraud. Of course, all of these entities use retrospective review — it is a normal and necessary part of any auditing system, but Medicare apparently has not felt similarly inclined. What the heck — it isn’t their money they are spending, and they don’t have a care in the world about operating profitably (another evil word in the D.C. lexicon).

They could have avoided this (and a lot of other financial problems) by inviting a few of the household “saver” types. My wife would have straightened them out in a snap.