Government Issues

• Payment for treatment over outcomes - Government funded programs were created for restorative care. However, the paying agent for the Government narrowed the interpretive guidelines down to only paying for treatment procedures, rather than the restorative process and the pursuit of outcomes. This violates the very intent of the Medicare guidelines that were enacted.
• In violation of Fox v. Bowen - Government's interpretative guidelines on paying for treatment over outcomes was overturned in 1986 by the court case Fox v. Bowen. However, the Government's fiscal intermediaries are still violating the decision. Agencies deny honest claims for Medicare benefits and the patients are forced into spending down their personal assets and going on the welfare program funded by Medicaid. As a result of non-adherence to Fox v. Bowen, Medicaid, the last resort, is going bankrupt on a service that legally is to be paid by Medicare Part A.
• Enforcement - The government's regulatory approach is enforcement, which has proven to be an ineffective method because it is focused on fining or closing facilities, or jailing the perpetrators.