Big Government Medicare Program Problems

Woodrow Wilcox
Jul 23
8 min read

Some people love big government and big government programs. They have a faith in government that is both enormous and imaginary. Any program or system made and operated by humans will have flaws. To think otherwise is unrealistic. The people who believe that big government is the answer to all our problems don’t want to hear that.

Some people think that if they don’t hear about problems, there are no problems. I believe that if you don’t hear about problems, then some people with special interests who want to keep the system as it is are blocking news about problems. Even with no news of problems, the problems still exist.

For the last 22 years, I have helped clients of the insurance agency where I work fight mistakes and fraud in the Medicare billing system. I have saved our clients a few million dollars.

Medicare billing problems are not unique to northwest Indiana. They occur wherever Medicare operates because the same systems, technology, policies, and oversight operate nationwide. Medicare related billing problems should happen all over the country on a rather evenly spread basis with variations caused by the number of senior citizens in any given area. What do you think would be a reasonable guess of how many seniors have had problems with Medicare related billing but had no one to help them? And how financially harmed are the seniors who are affected by such problems annually?

If the congressional district where I live and work in northwest Indiana is average, then it would be a good model to study. In 2023, Indiana’s first congressional district had 147,000 people age 65 or older. Indiana has about 10% of its population on Medicaid for all ages which is about 688,000. Let’s say that half on Medicaid are seniors (344,000) and that 10% of those are in the first district (34,400). Indiana’s Veterans numbered 177,426 in 2023. About 10% of the state population is in the first district. So, about 17,800 veterans should live in the first district. Veterans might use Tricare or VA benefits rather than Medicare alone. Medicaid is a different system than just Medicare alone. Let’s review the numbers.

Population 65+ in district is 147,000.

Subtract seniors on Medicaid (34,400).

Subtract veterans who use Tricare or VA more than Medicare (17,800).

Balance of seniors who are likely to use only Medicare is 94,800.

Seniors who use only Medicare are the primary group of people that our insurance agency seeks to serve.

Since I started helping clients of the agency where I work, the agency has grown from 2,000 senior citizen clients to 22,000 senior citizen clients. Most of our clients are in the first congressional district where we have our five offices. When I started helping seniors in 2003, our insurance agency had only one office with three insurance agents and three staff. Now, we have five offices with a dozen agents and a dozen staff. Everyone at the agency worked hard to build the firm. But I believe that helping clients with Medicare related medical bill problems was a major draw of many senior clients. I believe we filled a need of helping with such problems. Such problems do not happen only in northwest Indiana.

While our agency grew, I averaged saving our clients between $1,500 and $3,500 per week. Sometimes, I got big cases. I had two cases where I saved a senior over $250,000. I had one case in 2024 in which I saved a client over $400,000. If we figure an average client roll of 10,000, then about 84,800 senior citizens in this congressional district who use only Medicare WERE NOT OUR AGENCY’S CLIENTS.

If any of the seniors who were not our clients had a Medicare related medical bill problem, they probably did not recognize the problem and paid the wrongful bill. Seniors tend to assume that all medical bills are accurate. That is a false assumption. If the Medicare problems were evenly spread in the district (as they should be), then there should have been EIGHT TIMES the problems and costs that I protected our clients from experiencing.

I averaged saving our clients around $120,000 to $150,000 per year. Let’s use a lower figure of $125,000 for this calculation. Eight times that would be $1,000,000. That’s just for the Medicare bill problems in ONE congressional district. Multiply that by 435 congressional districts and the total per year is $435,000,000 nationwide of wrongful bills that seniors are pushed to pay. By “pushed” I mean that medical firms and medical bill collectors will “hound” the seniors until they pay. Medicare is not protecting seniors very well from the wrongful bills.

That is how big the problem is. The $435 million hit is a big financial burden on our nation’s senior citizens. It is too much a burden on them.

These seniors who are victims of Medicare billing problems are being tricked, “mugged”, and robbed by a system that does not protect them from its errors and flaws.

No normal person likes someone who mugs and robs a senior citizen. But that is exactly what the flaws in our Medicare system cause to be done to seniors. Some of the flaws have existed for decades. I believe that federal government officials, and others, have known about and ignored these problems for a long time. The problems that hurt seniors do not hurt the paychecks of government officials or vendors of the Medicare system. So, no one in the Medicare system has been motivated to fix the problems that harm seniors.

Protecting our seniors from financial harm should be a cause that unites Democrats, Republicans, and others to make senior citizens’ lives better.

I have helped seniors fight mistakes and fraud in the Medicare system over 22 years. Let me give you some examples of the kinds of wrongful billing that happen in the current system.

A hospital in Chicago, wrongfully billed our client for $188. The client and I tried to reason with the patient billing people at the hospital. We had the proof on his Medicare Summary Notice about the claim. The claim information on the Medicare Summary Notice that the client gets should be the same information on the Medicare Explanation of Benefits that the hospital gets. But I have found that many hospital patient billing personnel don’t read and follow the rules of Medicare (or they can’t). The hospital had no right to bill the client $188. So, I researched and found the name and the address of the Chief Executive Officer of the hospital and typed a letter for the client to sign. The letter and a page of the Medicare Summary Notice that showed we were correct was sent to the CEO. A few days later, our client phoned me to tell me that he got a phone call from an aide of the CEO of that hospital. The aide to the CEO apologized profusely for billing our client $188 and violating the ruling of Medicare in order to do so.

A hospital ignored a ruling by Medicare that it could not charge a senior more than zero for a certain service. But the hospital billed the senior over $700 wrongfully. I helped the senior file a complaint against the hospital for dishonest and bad business practices. The hospital was stopped from pursuing the bill against the senior.

A hospital missed the deadline for filing claims with Medicare. So, it billed the widow of the patient for almost $400,000. The hospital ignored and violated several Medicare rules. I helped the widow file a complaint against the hospital for dishonest and bad business practices. The bill was stopped.

A collection firm billed $900 to a client from Chesterton, Indiana. The original bill was over two years old. Medicare had the claim information in the archived files. It takes longer to get a file from archives because it must be reactivated and then requested again. I helped the client get the original Medicare Summary Notice report about the claim that the collection company was pursuing. The client and I sent a letter to the collection company to stop trying to collect. The Medicare report showed that Medicare told the hospital that it had no right to the $900 that it charged and billed our client. The hospital dishonestly waited two years for the claim to get to Medicare archives and then sent the bad claim to a collection firm to collect. When the collection firm realized that the hospital patient billing people had lied to it, it wisely ended the pursuit of our client for the $900.

A medical billing company cashed checks it received from our clients’ insurance companies but then billed our senior citizen clients for the same amounts. The medical billing company was trying to collect the balances owed twice. I caught them and started helping our clients file complaints against the billing company. The doctor who led the medical firm phoned me and asked for the names of about 50 of our clients who were being cheated by the medical billing company. The doctor was honorable and worked with me to reverse the harm caused to our clients by the dishonest medical billing company.

In 2017, one of our clients was being mistreated by both Medicare and Social Security. Medicare overpaid a doctor that our client used. Then, Medicare demanded that the patient pay back the money that Medicare overpaid the doctor. Then, Medicare got Social Security to start taking money from the senior citizen’s monthly Social Security check. Then, the client contacted me to get help. That’s when I got involved. We asked our congressman for help to deal with two federal agencies who were wrongfully taking money from our senior citizen client from Gary, Indiana. Then Congressman Pete Visclosky had his senior federal caseworker Mary Gurnak help us. The problem was fixed. The Social Security funds were fully restored to our client. Medicare was forced to stop its action against our client and pursue the doctor for a refund of the overpayment.

In early 2025, a medical billing company accused me of owing $2,690. Little did they know with whom they were dealing. I reviewed the paperwork that I had regarding the bill.

I filed a complaint with the Indiana Attorney General Department of Consumer Protection. I specifically detailed the information where I believed the medical billing firm had violated the law and my rights.

The Indiana Attorney General sent a copy of my complaint to the medical billing company and asked for their side of the story. They wrote a nice letter explaining their side and agreeing that the medical billing was goofed by some other associates used by their firm in the process. They admitted that the mistakes made the bill false and wrongful and agreed to drop the matter so that I owed NOTHING. That saved me $2,690. But most seniors my age would not have known how to fight such a wrongful bill.

In my book SOLVING MEDICARE PROBLEM$, I told the story of a doctor in the Chicago area to murdered a patient who was willing to testify that the doctor falsely filed claims to Medicare and got paid for medical services that he never performed on the patient. The doctor was caught and convicted for both cheating Medicare and murdering the patient.

There are many ways that the Medicare system that was supposed to help seniors with medical bills has become a system for “shaking down” seniors to drain their bank accounts while hospitals, labs, doctors, billing companies, government officials, vendors, and others get paid very well from the Medicare system as it is now.

I want to change that. I want to protect seniors. Do you want to help me?

Woodrow Wilcox wrote the book SOLVING MEDICARE PROBLEM$.

For over 22 years, Woodrow Wilcox has been the senior medical bill case worker

at Senior Care Insurance Services in Merrillville, Indiana.

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