NCPA - National Center for Policy Analysis


January 10, 2005

An ordinary toad successfully provided more accurate responses to Medicare policy questions than Medicare customer service representatives (CSRs), according to a new study by L.R. Huntoon, a practicing neurologist and editor-in-chief of the Journal of American Physicians and Surgeons.

  • A 2004 Government Accountability Office (formerly the General Accounting Office) study reveals that 96 percent of the time CSRs gave the wrong answer to physicians questioning the appropriate way to bill Medicare.
  • In comparison, Huntoon asked a toad a series of rephrased GAO Medicare policy questions; by jumping right for "yes" and left for "no," the toad crushed the competition, answering correctly 50 percent of the time.
  • In the GAO's 2004 study, the CSRs were aware of their evaluations and the questions were taken directly from the carrier's own website, yet, they still managed to lose to the toad 46 percent of the time.

While Huntoon's personal experiment is humorous, it barely begins to demonstrate the severe incompetence and inefficiency of the Centers for Medicare and Medicaid Services (CMS):

  • In 2003, Medicare received a total of 21 million "provider" inquiries; of those 21 million, Medicare's error rate would translate to 20,160,000 wrong answers.
  • GAO estimates that 500,000 of the 21 million were policy-oriented; overall, between 480,000 and 20,160,000 Medicare claims are incorrectly denied due to the incorrect information provided by Medicare representatives.

CSRs are not held accountable for giving accurate information, says Huntoon. The 2004 GAO study reasserted, "[W]e reported in 2002 that CMS's definition of what constitutes accuracy is neither clear nor specific...CMS has not revised the definition."

With no accurate definition of accurate, it appears that CMS considers accuracy and competence to be irrelevant, says Huntoon.

Sources: Lawrence R. Huntoon, "Medicare: Incompetence-Based Bureaucracy," Journal of American Physicians and Surgeons, Volume 9, Number 4, Winter 2004; U.S. General Accounting Office, "Medicare: Communications with Physicians can be Improved," February 27, 2002; and U.S. Government Accountability office, "Medicare: Call Centers Need to Improve Responses to Policy-Oriented Questions from Providers," July 2004.

For GAO 2004 Study

For GAO 2002 Study


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