Medicare & Social Security

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  • Options for Medical Billing Fraud

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    Jun 9, 2021

    i teach part time. My school district wanted a renewed TB test. The city clinic is closed. I scheduled an appointment with my doctor for the TB test. i went for the prick on a Friday and returned the next Monday for the reading. It was all handled by an assistant or technician. At the reading I passed my doctor in the hall, and he waved at me. He may have stuck his head in the door to say "hi'. He certainly never examined me or came near me. I was shocked today to see the billing statements. He billed Medicare and my Medigap plan for about $350, which included a doctor patient visit. Most was paid by the Medigap Insurer, a bit by Medicare. I have a $21 co-pay.

    There are paid clinics that give these tests for about $38, but most of them are for specific groups like Asian Health Clinic, etc. which is why I went to my primary care doctor.

    Shall I report this as Medicare fraud? Or just let it go.

    By the way, looking for recommendations for another primary care doctor.

    Jun 9, 2021

    For reference, my daughter (20 yrs old) got a tb test a few weeks ago from her primary care practice (Stanford Health) and they billed our insurance (Cigna) $48.00.  Cigna paid $8.67 and we paid nothing.  I am pretty sure they are not allowed to bill separately for the visit in this case -- if you have the CPT codes you can probably google them to learn more (unless maybe there are different rules for Medicare?).  Medical billing is fraught with errors.  Since this didn't really affect your bottom line, you could definitely ignore it.  But if it's going to gnaw at you (which I would totally understand), call the billing department at your doctor's office.  It could be a simple clerical error.  If you're still not satisfied, call your insurer.  I have found that true errors are usually eventually caught in an audit process on one end or the other (even months down the line you may receive an updated billing statement from your doc, or a revised EOB from your insurer).  

    Jun 16, 2021

    Hi. I think your instincts are good and that this is likely to be fraud. Please take the time to report. You can report fraud by phone to Medicare. If you don’t report it…it will just keep going on. We’re all paying for fraud.
    1-800-633-4227. Thx!

    Jun 16, 2021

    I appreciate your concern and sticker shock.  However PLEASE do not report this practice as fraud.  I am a physician--practice public health not clinical medicine--and am a Health for all --with Bernie on this one.  BUT the reimbursement policies in this country are INSANE (Medicare can get away with paying pennies on the dollar for actual cost) and the bureaucracy is astounding.  Let the bureaucracy go after the folks bilking all of us for millions with truly fraudulent billing, and take a deep breath over what this practice has chosen to do for likely their financial survival--(assuming they are an independent practice, and this isn't Sutter-- if it is-Sutter-go ahead and report them!!!)

    Jun 16, 2021

    At UCSF (where I work) “assistants or technicians” are not allowed to place TB skin tests (PPDs) or read them (i.e. evaluate for a skin reaction) - you have to be a designated reader, which is a nurse manager, a nurse practitioner, Physician Assistant, or MD. I’m assuming someone in one of these roles conducted your visits, in which case the clinic needs to be reimbursed for their time and care. Who else would pay if they didn’t bill your insurance (Medicare)? If it was a mid-level provider (NP or PA) the visit would have been supervised by the MD (in the office, not necessarily in the room), but the MDs name would probably end up on the bill/charges. 

    Jun 16, 2021

  • Psychiatrist who takes Medicare?

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    Jul 16, 2016

    I have a family member who needs medication for depression. We cannot find a psychiatrist who will take Medicare as insurance or who at least will take cash.*

    We'd prefer Berkeley/Oakland but will travel around the Bay Area.

    Thanks in Advance.

    * (It's hard to find docs who will take cash since if they take Medicare from one person then by law they must take it from every patient they see who has Medicare.)

    Jul 16, 2016

    Judith David in Berkeley is a psychologist, not a psychiatrist. She doesn't prescribe and I doubt she would rush to do so. But if your family member has medical coverage, she will work with the depression. She takes medicare, she's great, 30-40 years experience but quite her own style. She works from a somatic and transpersonal philosophy. I would recommend at least calling her to see if there's compatibility. 510-883-4656. Good luck.

    Jul 21, 2016

Archived Q&A and Reviews

Questions Related Pages

Advisor for Sosial Security Benefits

Feb 2013

Does this role/profession exist?: Advisors for Social Security and Medicare benefits? e.g., how to plan, best steps to take? I have three people in my life very close to me who are turning 65, and need help navigating the system. I know you can call the agencies directly - I thought there might be people outside the systems who can advise, in order to maximize available benefits in each individual's situation. I do know that there are financial advisors who might advise on SS benefits as part of their services - but my impression is that they do this along with selling a financial product, like annuities, so that is their perspective. (Not rejecting the idea of purchasing financial products if that is the best solution - but we need an objective eye to see if that might truly be a best solution.)

HICAP gives free advice on Medicare issues and problems and they are volunteers who do it for free.I would call your local Senior Center and tell them you would like to meet with someone from HICAP for Medicare advice.Maybe they can point you in the right direction for your other concerns. Ellen

A financial advisor should be able to update you on current social security issues. You still, however, should be delving all the reading you can get your hands on to make it work for you. Some financial advisors know WAY more about it than others. There are no specific professionals for this area as far as I know. I would call social security also and find out about perhaps local seminars given by your community. Remember, the laws CHANGE. For instance, there was a provision where a person could draw social security at 62, the lower rates, then repay and recalculate at are 66. THAT practice is now gone. So the issues can be different all the time. almost at soc security age

I highly recommend Lan Shaw of Edward Jones Investments for social security and medicare benefits advice. Her office is in downtown Berkeley across from the Brower Center. She has extensive knowledge and experience on these benefits. She is very helpful in helping to understand how social security fits into the overall retirement income plan; when you should start taking the benefit; taxes and how they may affect your benefits. She also can help develop a strategy to maximize the benefit for you and your spouse. Her contact info is phone# 510-704-8854. Email: lan.shaw [at] edwardjones.com Lisa