Why We Cannot Blame Obamacare for All Our Problems

When I talk to people about my experiences with healthcare fraud and warn them to remain vigilant, inevitably I direct them to this blog for more information. A typical reply I receive is “my insurance comes through my employer.”A photo of happy male doctor discussing with patient in clinic. Smiling medical professional is sitting at desk. Man is consulting healthcare practitioner in office.

I believe this reflects the fundamental misunderstanding about what healthcare reform truly is. The Affordable Care Act (commonly referred to as “Obamacare”) is a law, not a type of insurance policy to be purchased. Though we may agree that Obamacare has many problems, it is not responsible for the weakness in payment structures that lead to fraud.

Whether you receive your insurance coverage through an employer’s plan, purchase a subsidized plan via the exchanges created by the ACA, buy a policy on the individual market or receive coverage via Medicare/Medicaid, you are at risk.

Your employer is no protection; it cannot verify independent of the doctor’s written record what services you received. If you read your written record and recognize inaccuracies, you are powerless to retrieve your payment, which came out of your wallet as premium, insurance out-of-pocket costs or reduced wages.

In fact, the personal stories told on this blog occurred prior to the Affordable Care Act’s creation of the exchanges in 2014. The insurers involved in my experiences were commercial companies and Medicare, not plans purchased through the ACA’s marketplace.

Regardless of your support or distaste for the ACA and its implementation, it has succeeded enabling 20-plus million people to obtain insurance coverage. This means that more people than ever before are susceptible to healthcare fraud.

Obamacare, nor potential replacement plans such as the “Patient Empowerment Act” proposed by Rep. Tom Price, Sen. John McCain and Sen. Sonny Perdue, do not reform the third-party payment system. Simply waiting for repeal of the ACA or a replacement plan like the “Patient Empowerment Act” will not solve these fundamental flaws in payment structure that too often result in fraud.

The time to call your state and federal representatives is now.

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