An article in today’s New York Times got me thinking. The article “Doctor Doesn’t Work Hard to hide Symptoms of Medicare Fraud “is the story of a physician who received somewhere between $13 and $20 million by 
filing claims on patients who were not even his own.
Yes, health insurance and Medicare help many people get the medical care they need. The flip side is, the third party payment system is responsible for much of our health care funding crisis. Why do I say this? To begin with, many people make decisions about their health care based on whether or not insurance will pay rather than evaluating whether or not the care or test is appropriate and balancing the risk versus benefit. Additionally, since they don’t consider insurance dollars to be their own, they are less likely to pay attention to the billing.
In the case of Dr. Sheth, even if the billing agencies, the Insurance Companies, and Medicare missed the warning signs, each and every patient should have received an EOB (Explanation of Benefits of the equivalent) and seen payments to a doctor they never even saw. People seem to forget that everyone who pays health insurance premiums or taxes is paying insurance bills, whether they are legitimate or not.
“Solving” the funding challenges around health care funding need to focus on education, awareness, patient advocacy, empowerment, and wellness. People need to have good information and use common sense when making choices about every aspect of both their health care and life style choices. Does it make sense that we can thrive on processed foods that come in boxes and have lots high fructose corn syrup? How about diet soda? We know the value of exercise. How many people exercise regularly? How about doctors’ recommendations for testing and care? Information and common sense are critical. If you doubt what I am saying about the importance of being aware and your own advocate, check out “Death By Medicine“.
Begin today. Learn more about nutrition, exercise, healthy lifestyles, reducing stress and any diagnoses you may have received. The ball is in YOUR COURT. Grab it and run with it.
