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Illegible Signatures Now Considered Fraud

Reporting-Medicare-FraudHow widespread is Medicare fraud?  The government is now reporting Medicare fraud rates almost three times higher than previously accounted for, at 47 billion dollars this year.  How could Medicare Fraud triple in a year?  The answer is simple.

In an effort to be more honest with data collecting, Obama ordered the new accounting into effect.  All part of the hope and change we always hear about.

It’s not clear whether Medicare fraud is actually worsening. Much of the increase in the last year is attributed to a change in the Health and Human Services Department’s methodology that imposes stricter documentation requirements and includes more improper payments — part of a data-collection effort being ordered government-wide by President Barack Obama next week to promote “honest budgeting” and accurate statistics.

And what are some of those increased requirements as they relate to the reporting of Medicare fraud?  Yes folks, the legibility of the physician signature.  Now that Obama’s administration has decided to play games with reporting Medicare and Medicaid fraud, their next step is to reduce the fraud from a make believe 12% to a more palatable 9%.  Of course, that still represents a more than doubling of the baseline Medicare fraud.

According to the report, the Bush administration from 2005-2008 reported improper payments of roughly 4 percent in the fee for service program, or about $17 billion total in 2008. Government officials at the time, however, typically did not consider a Medicare payment improper if the medical documentation was incomplete or a doctor’s signature was illegible. Since these were flaws that ordinarily bar payment, that methodology drew complaints from government auditors that the figures were understated.

I haven’t written a legible signature since my first day of medical school.  After signing my signature, I would suspect over 100,000 times since I started clinical medicine, my doctor signature is nothing more than a line, a one inch by one inch diagonal line.  Now that the Joint Commission has cracked down on the dating and timing of verbal orders that have already been dated and timed once by the nurse, I simply do  not have time to offer the chart a legible signature.  Instead I offer the chart my doctor identification number, which is becoming more illegible every time I am forced to duplicate unnecessary documentation.  I fear to think what my Medicare documentation will look like as I close in on 200,000 signatures.

Perhaps Obama would like to consider my 45 minutes of intensive care work to be fraud because he couldn’t read my signature?  Perhaps if he simply asks me if the documentation is mine I would tell him yes.  Instead, we have more economic games that won’t fix anything.

It appears to me that Medicare is going to save 10 billion dollars by not paying physicians who have illegible signatures.  I have just one thing to say.  If Medicare and Medicaid stop paying physicians for work done because their signature is illegible,  there wouldn’t be a doctor in this country that collects money for work provided.  Find me a physician with a legible signature and I’ll bet you they aren’t an MD. Perhaps they are a nurse practitioner in disguise.  But give them 40 years to catch up in the signature work load and they too will one day be banned from earning a living by taking care of the old and the poor.

*This blog post was originally published at The Happy Hospitalist*

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One Response to “Illegible Signatures Now Considered Fraud”

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