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Tuesday, January 27

The Toad Method vs Incomprehensible Government Language

From a recent column at WND by Dr Lee Hieb :
[...]
I have some experience in dealing with codes and [government phone] help lines. As a physician, not only do I confront the IRS yearly, but on a very personal and up front way we in private practice confront the Medicare/Medicaid codes. These codes flow over 150,000 pages – and that estimate was 10 years ago, before any of the Obamacare nightmare began to add to the volume.
[...]
Even when you get advice [from Medicare] it may be wrong. A GAO (Government Accountability Office) study done in 2002 reported that 85 percent of the time when advising a medical client, the Medicare customer service representative gave incorrect advice.

After this dismal report card the government set out to do corrective action, and by 2004 [found in a study that] 96 percent of the time the Medicare representative gave wrong information.

These were not surprise quizzes. The response center knew they were being tested, and, "The questions represented common, policy-oriented questions concerning the proper way to bill Medicare in order to obtain payment."

Surprisingly, the CMS [Center for Medicare and Medicaid Services] had some insight into the problem. As reported by Larry Huntoon, M.D., Ph.D. in the Journal of American Physicians and Surgeons 2004: Among other things, the GAO found that Medicare policies and regulations were so complex and confusing that neither Medicare CSRs [customer service representatives] nor CMS policy experts could understand them.

"CMS officials acknowledged that some policies contain complex language. In addition, they told us that the agency's goal of quickly publishing a policy that is technically correct may sometimes overshadow its effort to develop a clear and understandable document."

In other words, in some cases they purposely publish incomprehensible Medicare policies. Needless to say, in spite of understanding the root cause of the problem, the government took the exact opposite approach and kept going down the same distorted road of unreality by adding thousands and thousands more pages of incomprehensible regulations in the form of Obamacare.

I haven't found an accurate count, but given that the bill itself is 2,400 pages, I will be surprised if our Health and Human Service opus is anything short of 200,000 pages at this time. NO human being can possibly understand this, although they continue to apply the legal maxim that "ignorance of the law is no excuse."

Now there may be some hope on the horizon for [physicians] and you in dealing with this IRS debacle. Dr. Huntoon, a neurologist in private practice ... took the Medicare questions and phrased them so a toad could answer "yes" or "no" by jumping right or left.

The Toad Method yielded a 50 percent incorrect response rate -- considerably better than the 96 percent incorrect response rate of the Medicare representatives.

(Apparently, being able to read actually makes one less able to understand the nuances of government regulations.)

So, this April 15, if you sit for hours [on the phone] waiting for an IRS representative, or perhaps have talked with a representative but couldn't understand or didn't trust the answer, just go outside and grab a toad (probably a frog would work as well, since Dr. Huntoon didn't really control the experiment for species), and double check the answer with Mr. Toad.

If you are audited, you can always take a copy of Dr. Huntoon's research paper with you and maybe even the toad as a demonstration.
As Dr Hieb emphasized, and as everyone who has flunked an IRS audit or the correct Medicare code knows, American government agencies make no allowance for ignorance of the law, and this includes failure to comprehend the language of the law.  But to pound home the point here's a story from her same column:
Like the IRS codes, we little people may not be able to comprehend (or even read) the [Medicare] codes, but we are responsible for being in compliance with the codes or face penalties.  And, just like the tax code, these penalties include fines, fines with triple damages, seizure of assets and jail time.

A dentist who was charged with fraud under the Medicaid code spent nearly seven years in prison, including considerable time in solitary confinement. Finally, at the end of his ordeal, he was released – and the government could only show that the poor dentist had overcharged Medicaid by about $40.

Unfortunately, he is not alone. When you hear your doctor is being charged with Medicare fraud, most of the time what is called "fraud" is choosing the wrong code from 150+ pages of regulation.

To avoid the government thump, practitioners go to great lengths to "be in compliance" with the codes. I did not feel I could safely navigate the Medicare code waters alone in my office. I paid 10 percent of my income to a billing service that itself had 160 employees and hired specialists in Medicare and Medicaid.[...]
If 10 percent sounds steep, the billing service has to go through hell and high water to wring comprehensible answers from CMS and I suspect at least 7 percent of the fee is for hiring clairvoyants to plumb the answers for meaning.
 
Given the stiff penalties for failure to comprehend incomprehensible language, American medical and dental practitioners might want to consider demanding that as long as the codes they supply to Medicare are Toad Compliant they should be exempt from criminal charges and triple fines. They should take the demand all the way to the Supreme Court, if necessary.  And be sure to enter a toad into the court proceedings.

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