Show #277 Airing Sunday, December 26th, 2004
Medicare is a very important program, providing health coverage for our nation’s elder citizens. On prior shows, I’ve talked about some of the benefits. These include payments for doctor and hospital services, therapies, rehab, home care, and even nursing home care.
Congress created the Medicare law years ago, specifying the services which are to be paid. But many legitimate claims are denied incorrectly. Perhaps this is Uncle Sam’s way of trying to save money. How can I be so sure that many claims are denied improperly? That’s easy. When denied claims are appealed, the vast majority of denials are overturned.
Denied claims are reviewed by Administrative Law Judges. These judges are independent of Medicare, they’re under the supervision of the Social Security Administration. They can apply the law objectively. And when they do, in most cases they find that the Medicare bureaucrats were wrong.
These reversals have forced the government to make a choice: Medicare could have decided start approving legitimate claims. That would have been the right thing to do; to stop violating the law, and to stop putting older folks through unnecessary stress and hassles. Sadly, that is not the path our government decided to follow.
Instead, Congress chose to move the Administrative Law Judges from the Social Security Administration to the Department of Health and Human Services. Hmmm, The Department of Health and Human Services is in charge of Medicare. In other words, the judges who have been reversing those Medicare decisions are now being put under the control of the Medicare agency itself.
Congress says that the judges can still be independent, and will still be permitted to decide appeals as they see fit. I’m sorry to say, but it’s just not gonna’ happen. You can’t constantly spit in the face of the person who signs your paychecks.
In fact, in another context, we have already seen what happens when supposedly “independent” judges are reviewing decisions made by the agency that pays them. Right here in Ohio, the law gives us the right to appeal decisions denying Medicaid claims. The state hearing officers who hear these appeals are supposed to be independent. But they’re hired by Medicaid, they’re paid by Medicaid, and they can be fired by Medicaid. Sometimes you can find a brave hearing officer who’s willing to buck the system and rule in favor of a claimant. But let me tell you, that’s rare. In most cases, the state hearing officers simply rubber stamp Medicaid claim denials, even those that are blatantly wrong.
And now Congress has decided to adopt a similar appeal process for Medicare. This is simply not fair. Just imagine if you sued an auto maker for selling you a lemon, and the judge worked for Ford or General Motors.
What can you do? Contact your congressman and tell them to give the Administrative Law Judges back their independence. Give them the job security they need and move them back under Social Security. Here’s the number to call: 202-224-3121
