Commentary : Medical Scams: the Public Suffers
The commercialization of medicine and government-forced sacrifice of long-established medical ethics, including the unrestrained use of medical advertising, has led to a variety of medical scams--and some outright fraud.
Many of these quasi-ethical medical enterprises seem to have first surfaced in Orange County.
One scenario is all too familiar. A medical entrepreneur contacts a retirement home or senior citizens center--any concentration of older citizens--and offers an allegedly “free stroke screening.” Most often, the offer is represented as a public service. The procedure provided is a quick and often sub-optimal ultrasound screen of the carotid arteries. The test, when properly done, ought to take from 30 to 60 minutes. My patients describe seeing dozens of people whisked through in an hour, and those records that I have been able to examine are often not of diagnostic quality.
But is this “public service” really free? I often find that to obtain the “free” examination, the patient did sign something and that something often turns out to be a Medicare form or a private insurance claim. From what I am able to learn from these patients, there is no serious attempt to collect the co-insurance, as required by law, and no explanation of benefits, so the patient gratefully and innocently accepts the service as a free offering.
Last week, I examined a 25-year-old woman who had no medical symptoms whatsoever! She didn’t even go to the doctor. Instead, the doctor, or more precisely, his sales representative, came to her. She explained that she was sitting in her office working when she received a telephone solicitation for a free medical examination, provided she had medical insurance. When she protested that her policy had a $500 deductible, the solicitor magnanimously offered to accept only that portion of her deductible that she wished to pay. Understandably, she wished to pay none, and the offer was accepted.
The young woman was able to provide me with copies of her records. They included in this completely symptom-free young adult an echo-cardiogram, an ultrasound study of her carotid arteries, ultrasound studies of the pancreas and gallbladder, more extensive blood chemistry studies than the average physician might order in a lifetime--every kind of examination except those that required a doctor. She thought she had had a thorough physical examination, but no doctor ever saw her.
Although she had an EKG and an echo-cardiogram, no one listened to her heart. Though she had a spirogram, no one listened to her lungs. No one checked her breasts, and no one did a pelvic exam or a Pap smear. No attempt was made to collect her deductible. Indeed, if you can bill someone for $2,000 for 30 minutes of work not even requiring a physician, why quibble about a deductible?
That very week at home, I took a call for my wife offering to sell her the same kind of free physical examination, provided she had medical insurance. Without revealing my identity as a physician, I asked about the deductible and was similarly assured that all she need pay was what whatever her conscience offered. Beyond telling me that it would be a very thorough Mayo Clinic-type exam, the salesman didn’t seem to know what tests would be done. It was very much like the boiler-room calls I used to get for aluminum siding a decade ago.
Another questionable game involves groups of medical vultures who employ doctors and perform physical examinations but pollute the effort by performing and charging exorbitantly for scores of exotic blood tests and myriad X-rays costing thousands of dollars--diagnostic tests that most well-trained physicians would have great difficulty in relating either to the patient’s complaint or diagnosis.
With each passing year, the cost of good medical care goes up, and this is reflected in higher premiums and/or restrictions in the scope of covered services.
Even when the true nature of the costly “free exam” is pointed out, some patients defensively argue, “Well, why not? I’ve paid into my insurance for years and never collected a cent.” But the other side of the coin, as the public is gradually learning, is that for every patient who has a thousand dollars’ worth of needless medical exploitation, another, far sicker, patient may be deprived of a badly needed hospital bed or a necessary doctor visit because the fund of available medical dollars is limited, whether it comes from an insurance company, the government or a private pocketbook.
The unscrupulous drain on already scarce medical resources is one of the factors already provoking spokesmen for medical rationing, such as former Colorado Gov. Richard D. Lamm, to advocate eliminating hip transplants, pacemakers, kidney dialysis and open heart surgery for “those who are destined to die.” Who is he talking about? We are all destined to die.
By allowing unrestricted medical advertising, government has announced its sanction of a return to the brutal policy of caveat emptor-- let the buyer beware. Therefore, medical buyer, be warned: There won’t be any “sticker in the window.” Medical dollars carelessly spent today may not be there when you really need them for a life-threatening crisis. If it seems too good to be true, it probably is.
