This could have been a Watchdog report about how a congressman’s office messed up. If that were true, nobody would be surprised. But it’s not.

Life in this low-rated 113th Congress is apparently so difficult for all involved that when I told the congressional office that this was a positive story, at first, they didn’t believe me.

It begins when I hear a complaint from Kala King of Garland. Her 80-year-old mother breaks her hip and receives physical therapy through home health care. The agency providing PT charges $1,200 for six sessions. But Medicare pays $2,083.

“Medicare paid nearly twice the amount that the agency billed the claim for,” King tells me.

Believing it’s a computer error, King calls Medicare to let them know they paid too much. What she hears surprises her. The Medicare representative tells her that there’s a standard amount of payment for such a service, and the system automatically pays that amount no matter the actual billing amount, even if it’s higher.

“This makes no sense to me,” King says. “It’s not cost-efficient. It just seems crazy to me and a waste of money. What am I missing here?”

Kala King

King says she contacted her congressman, Rep. Pete Sessions, R-Dallas, but she never received an answer. Instead, she says, she starts receiving Sessions’ newsletter.

News of this kind aggravates The Watchdog. When you contact elected officials, The Watchdog believes, they should respond in a timely and accurate manner.

But when King tells me she contacted Sessions through his website, I realize that’s the problem. Website communication with any government agency is often a big fail. Nothing works better, I believe, than a phone call or, even better, an actual office visit. Give a face and name to a problem. I suggest to King that she get in touch with a Sessions caseworker in person.

As readers of The Dallas Morning News Dave Lieber Watchdog column first learned, I decide to follow this journey. This is like mystery shopping a government office, similar to the way major companies send secret shoppers into their retail stores to see how shoppers are treated. Can King get a straight answer? If she can’t, you’ll know in another negative story about the 113th Congress that will surprise nobody.

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Sessions caseworker Jennifer Lang of the Dallas office is assigned the case. She is the Medicare and Social Security specialist. It takes several weeks of back and forth with the Centers for Medicare & Medicaid Services, but Lang gets an explanation. She tells King. King tells me. Now I’ll tell you.

Jennifer Lang

Medicare uses something called a “prospective payment system” to make these payments. The services involving home health agency visits are bundled. So even though the only service King’s mother receives is physical therapy, it’s bundled with other services such as nursing, occupational therapy and speech-language therapy that she does not receive.

A Medicare official tells the congressman’s caseworker that sometimes the billing amount comes in low and, as happened with King’s mother, the payment is higher. Other times, the billing amount is high, but bill payment is lower. Either way, the Medicare official explains, they cancel each other out. Really?

The Medicare official explains that this system is better than the old system, which paid per visit. The problem was that service agencies had a financial incentive to make more visits, even if the visits were unnecessary, so they could make more money. The new system is supposed to cut back on that kind of abuse by creating standard payment amounts. At least, that’s the logic.

King isn’t pleased with the answer. She believes, frankly, that it’s dumb to overpay. Why not simply pay the billed amount, whatever it is, rather than a fixed charge? Why not cap the amount? Why not depend on a doctor’s letter to determine what’s needed? Those are King’s ideas.

But Medicare makes the rules.

What I like is that King gets her answer in detail. This is what the Founding Fathers imagined when they created a U.S. House. Hundreds of representatives from small districts across the nation, running for election every two years, accountable to the people. We all know it often doesn’t work that way.

Medicare announced in June that it’s changing some of its payment rules next year. Medicare payouts to home health agencies are about $18 billion a year. The changes will save about $290 million. That’s a drop in the bucket. At least it’s something.

I wanted to tell you about Kala King, the asker of questions, and Jennifer Lang, the answerer, because this is the way representative democracy is supposed to work.

“I figured if this happens in our bill, it happens in lots of bills,” King says. “And if you multiply it across the United States, I figure it’s a very large waste of money.”

Lang says, “We understand that sometimes it’s hard for consumers to deal with government agencies…. I was just doing my job.”

Too bad that alone is today’s world is enough to muster special attention.

U.S. Rep Pete Sessions

Here’s an alert to all federal, state, county, local and school district officials: You never know when a constituent asking you for help is actually a mystery shopper for The Watchdog. I’ll be doing this again. And again.

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Are you tired of fighting the bank, the credit card company, the electric company and the phone company? They can be worse than scammers the way they treat customers. A popular book, Dave Lieber’s Watchdog Nation: Bite Back When Businesses and Scammers Do You Wrong, shows you how to fight back — and win! The book is available at WatchdogNation.com as a hardcover, CD audio book, e-book and hey, what else do you need? The author is The Watchdog columnist for The Dallas Morning News. Visit our store. Now revised and expanded, the book won two national book awards for social change. Twitter @DaveLieber

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