As is true with most of life's problems, what we can do is often not what we should do. We can refuse to treat Medicare patients, but this is contrary to our Hippocratic oath to treat without regard to pay, and it penalizes the elderly from getting optimal anesthesia care. We can avoid the risk of being sued by the government for Medicare fraud by not submitting claims for reimbursement. That would go a long way toward balancing the Medicare budget, but most physicians prefer to direct their charity toward more noble institutions or endeavors. What may have started out as a simple contractual requirement for reimbursement of services rendered has become, over the years, a morass of governmental interagency micro-management.
Physicians submit claims for payment for services to a variety of payers.
Each has different criteria for types of services they will reimburse and what documentation they require before payment will be made. When Medicare reimbursement first began, physicians and their billing agents learned those guidelines like they did for any other payer. Physicians found it easier to understand the legal dynamics of professional liability relating to medical malpractice and paid for insurance against such actions, realizing we are fallible and human. Now we must learn a whole new area of our practice relating to the legal obligations to defend ourselves against charges of fraud and abuse. We also need to understand the consequences, financial and even criminal, of being deemed guilty of an offense for which we almost certainly have no insurance.