Medicare and Medicaid Overages….Local Examples

A commercial just on had the phrase, “We’re working to reduce Medicare fraud.”

I am not old enough to benefit, but got to experience Medicare/Medicaid a little over a decade ago when my 93yr old grandmother moved in. She had outlived her husband and both her sons, and I was next in line…. I survived.

While here, I managed her massive medicine collection. She was on both medicare and Medicaid, so I never had out of pocket expense for her medical bills. Eventually, for her own safety, we transferred her to a local nursing home. What an eye-opening experience (for me). Just a couple examples. The nursing home staff was wonderful, by the way.

I still received the Medicaid paperwork. One of her prescriptions had been about $20. Once she was in the nursing home, that exact same medicine was billed to Medicaid at over $100. Who got the extra money? The nursing home? The pharmacy? The medicine manufacturer? All of the above? The only two physical differences were that her medication was all individually packaged there …. and a registered nurse gave it to her.

Doctor bills to Medicaid seemed normal while she was with me, but were tripled and much more frequent once she transferred. I would have thought slightly higher, because the doctor went to her…..but triple? And she suddenly had additional doctors coming from all sorts of different directions. So an individual doctor can go TO the nursing home and in one visit to the home, stop in to see 10 patients, and bill out well over $1000? Not bad for an hour’s work. She had so much medicine happening that, within a very short time, was almost completely comatose and barely alive. Because of that year, I have a modified view of end of life care…..another post sometime.

Another example was a trip to the hospital. It was a non-emergency trip, but the nursing home used an ambulance to transport her (about 5 miles) to the hospital because she was very fragile and they didn’t want to use their van (nor my car). I agreed. Without sirens, the trip took under 10 minutes each way. An hour later she was transported back.

I received two identical $850 invoices. It didn’t cost me anything, but I was troubled by it so I called. I was sure it was an accidental duplication of the round trip invoice. NO! Those were the ONE WAY charges. That conversation included the following:

“I think you accidentally double-billed for my grandmother’s ambulance transportation to the hospital.”

“Sir, those are not invoices to YOU.”

“I understand, but I still think there is a mistake here.”

“Again sir, this is not coming out of your pocket. Those invoices cost you nothing. And….as I check, those are the charges for each of her transports.” 

I’m not slamming the nursing home community, the paramedics or the hospital…..I’m slamming the system.

We don’t need to cut people out of Medicare/Medicaid. Multiply those types of potential savings by the rapidly increasing number of senior citizens…. and THERE IS YOUR REDUCED MEDICARE/MEDICAID EXPENSE.

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