Let's assume you are correct or at worst there is grey zone room for interpretation and the insurance company is being ridiculous....
Meanwhile our country is hemorrhaging money on real medical fraud.
- Oregon several years back lost like ~300 million in medicaid
- Smattering of doctors and medicare fraud, I usually see about 2 pop up on news per year, in 2-30 million dollars
- Somalians and daycares in MN
- Somalians and medical transport in MN
- California Hospice and medical transport
- Health systems as outlined out by the social media doc, the glaucofleckem or something like that with characters of Timothy, Jimothy, etc
- Insurance companies themselves thru denials, PAs etc
Every day doctors trying to stay in the lane, do well, do right, and fraud is gutting the heart and possible financial solvency of some of these programs. Adding layers of bureacracy to prevent fraud, but yet doesn't seem to fully do it, but merely weigh down the every day doc and every day small hospital that's simply trying to make the numbers pencil out in a high medicaid/medicare insurance mix. I know personally one non-psych doc who had a private practice and strived to take medicaid for the societal greater good in the practice but the layers of bureacracy in claim submission with almost everyone, and denials, or slow rate of pay, all stretched out over more than a year, brought the harsh reality to the doc, medicaid had to be dropped as was expending too much time, staff hours, and getting nothing - was better off just doing charity care.
And yet, when large systems are caught they get a lower punishment then what would be considered punitive enough to truly prevent such behavior. [to think the US used to hang people for stealing a single horse or cow] Or when people seek to uncover the scammers like somalians in MN or in CA or other locations the political left throws a fit in the usual fashion. Even the Oregon medicaid screwup I don't recall seeing any real consequences or changes, just, oh we found a screw up, our bad, shoulder shrug.
In summary this is one of those weights on the burnout of physicians at a low level, and a sign of greater social/cultural decay at a higher level.
