NCPA - National Center for Policy Analysis

Why Doctors Dislike Medicare

April 2, 2002

A federal appeals court recently threw out the criminal convictions of two former executives of HCA Inc. -- the nation's largest hospital owner -- on charges they engaged in Medicare fraud. One had been sentenced to 33 months in prison in 1999 for allegedly overbilling Medicare for nearly $3 million.

The crux of the case involved interpretation of Medicare's complex, confusing and ambiguous claim rules.

After the appeals panel reviewed the evidence, it concluded "competing interpretations of the applicable law are far too reasonable to justify these convictions." In other words, HCA's reading of the rule made as much sense as the Justice Department's.

  • Critics point out that a good deal of the confusion stems from Congress adding layer upon layer of regulations, price controls and coverage limits to Medicare laws.
  • The Mayo Clinic once counted more than 100,000 pages of Medicare regulations, rulings and bulletins it must adhere to.
  • The threat of losing one's livelihood, career, reputation and even freedom for misinterpreting such a document must be playing a role in the decision of a large number of doctors to stop seeing new Medicare patients.
  • According to the American Academy of Family Physicians, 17 percent of family doctors refuse to take new Medicare patients.

Patients may soon come to detest Medicare as we know it, observers warn, when they find they are having fewer doctors to chose from and experience lower quality care.

Source: Editorial, "The Medicare Police," Wall Street Journal, April 1, 2002.


Browse more articles on Health Issues