Our greeting of, "Happy New Year," reflects hope that the future will bring good luck or at least relief from past misfortune. My best years were when I was well fed, comfortable, and blessed with the degree of good health that permitted camaraderie with family and friends. But, when I didn't want to repeat a challenging year, I tersely responded to those wishing me a happy one with the cynical observation, "It has to be better. Nothing can be as bad as the last one."


This year may show improvement. We have the attention of our lawmakers. They have slowed down. Major changes to the delivery and funding of our medical care systems will be implemented in bits and pieces. That will give us time to adapt.


My disenchantment with single-payer health care began years ago when Mom was widowed and asked me to help decipher her Medicare Summary Notices. We discovered the hospital sub-let their billing to a subsidiary organization that re-billed for the same charges that Medicare had already reimbursed. It took weeks, many phone calls to the hospital, the second biller, Mom's supplemental insurance carrier, and Medicare to have this corrected. I wondered why Medicare hadn't discovered this without our help. The duplicate billing was for the same patient, on the same dates, for the same procedures, and charged to the same coding. Surely the government could implement cross-checking in their data bases and save Mom and I all that trouble. We personally had nothing to gain for resolving this except as taxpayers to whom the overcharge would ultimately have to be absorbed through our payments of Medicare Tax.


Medicare doesn't pay for every claim submitted to them. Sometimes disallowances are costs the medical provider has to absorb. I've seen Medicare disallow a particular treatment used by one doctor but allow it by another doctor although both used the same billing code. Once a charge for oxygen was disallowed for a paralyzed patient carried out of the house on a body-board by paramedics because oxygen (or perhaps breathing) was deemed unnecessary in transit to the hospital. It's discouraging to know that protesting these disallowances fell on deaf ears while billing "errors" are processed and paid.


I've reported medical procedures that doctors billed more than once. The insurance company processing for Medicare defended these billings explaining that contracts with the doctors are renewed annually and sometimes billing codes are changed with the current contract year. But when I argued that treatment is done on a date certain and re-billing with a different date using the new codes is clearly duplication and perhaps fraud, the company representative said, "she didn't know what she could do about that."


Two years ago a doctor charged for a surgery that was not performed. I informed the insurance company representative on the Fraud Hotline that we had a witness who could testify to this. Her response was that "although they usually don't investigate billing errors, in this case, someone would be in touch with me for follow-up information" to date that has not happened.


Pages 96 and 97 of the 2010 Medicare & You publication as well as the Medicare website elaborate on procedures we can use to protect ourselves from Medicare Fraud. It suggests the government is committed to help us weed out those who are scamming the system. But, it starts with calls from us and it remains to be seen if their words are backed up by action. I will continue to follow their reporting procedures. If any of these reports ends up being investigated and overturned, You'll be the first I'll let know.


In the meantime, if you haven't yet lost all your financial resources, I hear that 2010 is a good year to die and take advantage in the one year window in the Estate Tax Law. I personally recommend against dying if you can. Instead we can hope that the next bundle of changes going through Congress, although written by lobbyists and special interests, might be beneficial to our comfort and good health. With that encouragement in mind I wish you a Happy New Year, or at least one that is an improvement over the last one.


A resident of Hesperia, Margaret E. Furman is a regular columnist for the Hesperia Star newspaper.