Well, sadly, the average American, who may have escaped such experience till now, will have the opportunity of taking on our overweening bureaucracy firsthand. As reported by the Associated Press, millions of families will need to file their taxes differently due to the Obamacare law, and these poor souls will be unlikely to find help from the IRS. Only 50 percent of people who call the IRS hotline are expected to get a human, and wait times in excess of 30 minutes are expected.
Now, this is not good, but at least the guy on the street may understand a little more what we physicians have been screaming about for years. The U.S. tax code was approximately 75,000 pages in length before Obamacare hit. Like government spending, one cannot get a consistent figure on the length of such codes, but this is in the ballpark. And if you ask an attorney "Do you understand the U.S. tax code?" he will wave his hands and refer you to a specialist tax attorney. Well, I have a tax attorney, and I can tell you that even the specialist tax attorneys throw up their hands and admit they really don't understand the minutiae of the code. They do your accounting and returns based on their best guess after reading the code and attending seminars. And they prepare to defend you as needed from the local IRS Gestapo. This year, compliance with the tax code becomes even more complex to account for the tax penalty carrot-and-stick nature of Obamacare. And not surprisingly, the bureaucracy is going to be all help short of true assistance.
I have some experience in dealing with codes and help lines. As a physician, not only do we 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. Like the IRS codes, we little people may not be able to comprehend (or even read) the code, 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.
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Unfortunately, he is not alone. When you hear your doctor is being charged with Medicare fraud, most of the time what is being called "fraud" is choosing the wrong code from those 150-plus pages of regulation. To avoid the government thump, practitioners go to great lengths to "be in compliance" with the codes. I paid 10 percent of my income to a billing service that itself had 160 employees and hired specialists in Medicare and Medicaid. I did not feel I could safely navigate the Medicare code waters alone in my office. Even the billing service, when calling the CMS hotline for help, would often be placed on hold for 30 or more minutes waiting for assistance – even though they had hundreds and probably thousands of claims to deal with at any given time. Of course, the Medicare hotline has rules, and the rule was you could only ask questions about three claims on any given call, no matter how many claims you needed help with.
But the final kicker is this. Even when you get advice, 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. Needless to say, after this dismal report card, the government set out to do corrective action, and by 2004, in a new study, 96 percent of the time the Medicare representative gave wrong information. Keep in mind 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."
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Surprisingly, the CMS folks had some insight into the problem. As reported by Larry Huntoon, M.D., Ph.D., in the Journal of American Physicians and Surgeons 2004:
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Among other things, the GAO found that Medicare policies and regulations were so complex and confusing that neither Medicare CSRs 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 of more pages of incomprehensible regulations in the form of Obamacare. I haven't found an accurate count, but given that the actual bill itself was 2,400 page, 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 us and for you dealing with this IRS debacle. Dr. Huntoon, a neurologist in private practice, has much experience in dealing with the Medicare/Obamacare bureaucracy. Having obtained a Ph.D. through some research skills, Dr. Huntoon decided to run his own test. He took the Medicare questions, and phrased the questions so a toad could answer them "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 actually read makes one less able to understand the nuances of government regulations.)
So, this April 15, if you sit for hours 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. Be cautious, however, because you always run the risk of insulting the agent by suggesting "the Toad Method" (TTM) is quicker and superior to the IRS hotline. And IRS agents are reported to become vicious when attacked and wounded. You'd be correct about the toad, but the toad can't post your bail.