Dear Patient: I didn't commit Medicare fraud. Here's why...
Questioned about the validity of her charges, the author
composed a letter that left little doubt that she was underpaid.
I recently received this letter from a patient I had successfully treated
Dear Dr. Rahn:
I am writing to complain about the bills you sent to Medicare after my
recent hospitalization. You came in every day to examine me and to discuss
test results and plans. But your visits were short and hurried. Your charges
for those days are clearly excessive.
I am doing well now and have no quarrel with the care I received. But
Medicare is asking us to report possible fraud and abuse by physicians.
Before I do that, I would like an explanation of your charges.
Once I'd overcome my anger, I decided to use the occasion as a "teaching
moment." Proper communication between doctor and patient, which is
always critical, has taken on even greater importance now that Medicare
has anointed our patients as watchdogs. We simply have to let them know
more about what we do for them--and why. In that spirit, I prepared the
following response for my skeptical patient.
I am glad you're making a good recovery after your recent hospitalization
for pneumonia. Although I regret that time pressures made it impossible
for me to visit with you as long I would have liked, there were other aspects
of your care--not clearly evident to you--that I devoted time and attention
to every day. This work began immediately after I examined you in my office
and determined that you had right middle lobe pneumonia. It continues to
1. Although current clinical guidelines recommended that I treat you
as an outpatient, experience told me you were too sick to combat your illness
at home. I arranged for your hospitalization.
2. I designed your care plan, ordered the correct laboratory tests, chose
the proper antibiotics, and wrote orders to the nurses, pharmacy, and respiratory
3. I reviewed your tests daily, considering whether there were other
tests I should order to track down possible abnormalities and correct problems.
At one point, for example, your blood sugar was quite high. To make sure
that test was an aberration and you weren't a diabetic, I arranged retesting,
which showed your blood sugar had returned to normal.
4. When your tests weren't available for review on schedule, I phoned
the lab and radiology department to get the results.
5. I visited the library to do a literature search of your monoclonal
gammopathy to see how this related to your pneumonia. I was pleased to find
my concern about your immune system was unwarranted.
6. I visited the radiology department to discuss with the radiologist
whether your X-ray suggested we needed a CT scan of your chest. We decided
to schedule the scan.
7. After I discussed the CT with you, I bargained with the ordering clerk
to get you in before the typical three-day wait. I again conferred with
the radiologist about the test results.
8. I tracked down the pulmonologist for a consult and conferred with
him about his findings.
9. I called in a cardiologist to clear you for the bronchoscopy, and
coordinated the timing of your tests.
10. I answered a note from the hospital pharmacy committee suggesting
that I switch you to oral antibiotics to save the hospital money. Since
I felt you would benefit from one more day of IV antibiotics, I persuaded
the committee that was necessary.
11. When respiratory therapy department staff suggested you had exceeded
the oxygen usage outlined in the protocol, I convinced them to continue
the oxygen, because you were still short of breath.
12. I took three or four phone calls each day from nurses informing me
of your vital signs or of test results.
13. I took a middle-of-the-night call seeking authorization for the sleeping
pill you requested because the hospital hallway was noisy.
14. When I suggested you could go home, but you objected because you
had no one to care for you, I convinced the utilization review nurse that
your hospital stay should be considered a medical necessity.
15. I met with the social worker to arrange for home health care, meals-on-wheels,
and respiratory therapy.
16. I made several calls to your family in Wyoming regarding your progress
and follow-up care.
17. I am now wading through a barrage of paperwork resulting from your
hospital admission and discharge, and your home health care.
I willingly spent time on these matters because I felt they constituted
good care and were essential to your comfort and recovery. I extend myself
similarly to all my patients--in ways that never appear on bills and are
not compensated by Medicare.
I look forward to your returning to my office for follow-up so that we
may both ensure your ongoing good health. Please continue to contact me
whenever you have questions.
Ada C. Rahn, MD
By Ada C. Rahn, MD, Internist/ Elmhurst, IL
Ada Rahn. Dear Patient: I didn't commit Medicare fraud. Here's why.... Medical Economics 1999;16:135.