Medicare fraud (rant)

[JayW]

The Diabetes Care Club recently sent me a request to sign an order for a vacuum erection system to treat impotence in one of my diabetic patients. Their intent was to send this device to my patient and bill Medicare for it. This patient happened to be coming in the following day for an appointment, and told me that he made no such request and had no desire or use for such a product.

 

Now, granted this would only have wasted a couple of hundred tax dollars, but this is just a typical example of what I have found to be a common practice with DME (durable medical equipment) suppliers who ship across state lines. Other common items that are requested include heating pads, braces, and excessive amounts of sugar testing supplies. Other companies such as Liberty and United States Medical Supply (among others) are equally guilty, and don't even get me starteed on the Scooter Store!

 

The point is that it is illegal for a DME supplier to directly "cold call" seniors to try and drum up Medicare business, and they certainly cannot fabricate a request for equipment that would then be reimbursed by Medicare.

 

This situation is way out of control The ads claim that, "We will take care of all the paperwork," but in reality they just send it to me and it gets added to the large stack of other forms I daily fill out and/or sign. Most busy doctors just take the company at their word, sign the order and the equipment gets shipped out and billed to Medicare.

 

I have had some success with turning the paperwork over to Medicare for fraud investigation. The FBI even came to my office to interview me on one case I reported, and it is my understanding that a hefty fine was then levied. I sent in another case to them today, but it took me about an hour to gather all the evidence, write a letter of explanation and get it in the mail.

 

I am relucatant to paint all such companies with such a broad stroke, but I am convinced that many many millions of our limited Medicare dollars have been wasted on DME that is neither wanted or needed.

 

On the other hand, I have found that local independent suppliers, and usually the local branches of chain pharmacies generally are honest, easily accessible and helpful if there is a problem with the equipment. I encourage my patients to support such businesses rather than the huge national ones such as those I mentioned earlier.

 

Well, I feel a little better now. I actually have a rather easy solution that would effectively eliminate this waste, and I'll share it if anyone cares to hear it.

 

Jay

[Slyder_Steve]

Jay,

You're doing all of us a great service and I, for one, thank you!

 

Slyder

 

Why can't there be some sort of form "sign off" by the patient for these services, stating they've requested this? Seems like an easy solution, but certainly won't cover all the fraud.

[Twisties]

The point is that it is illegal for a DME supplier to directly "cold call" seniors to try and drum up Medicare business

 

I wonder if this restriction on the brand spankin' new corporate right to free speech will be the next to fall.

 

Thank you for doing what you can about it and letting us know what's happening. Proud of ya!

[Paul Mihalka]

Yep. I had one knee accident (torn tendon) about 7 years ago, and another, fracture of tibial plateau, about 3 years ago. From the first I kept the crutches and the walking cane. After the second event I had a very hard time rejecting the crutches and cane they wanted to "give" me at the doctor's clinic.

[lawnchairboy]

I think the solution is to just have one huge organization responsible for all billing, payments, and processing of pharmacological and durable medical supplies and equipment; aw heck, why not the whole shooting match?

 

That way, all this fraud would just stop cold.

 

Just look at the job as it is being done today.

 

Think of the efficiency we could achieve.

 

 

[Selden]

That's not Medicare, per se, but the way our medical system works. You can be 16, and they'll still do the same thing re equipment. It's part and parcel of divorcing the actual costs of things from patients' knowledge via the insurance system.

 

Kudos to Jay for attempting to inject a note of reality. If every doctor and patient did this, Medicare fraud would take a dive.

[upflying]

I'll take that extra vacuum erection system if you don't need it.

 

Seriously though, did the now apparently dead Health Care Bills in the House and Senate address the issue of this fraud?

[Polo]

Investing an hour of your day in collecting evidence and composing a letter is something that will curve the interest of many a lesser man. Thanks!

 

I agree with Selden about the whole approach to insurance and false claims. January of 2008, my knee somehow thought it would be fun to make contact with the chainsaw, luckily it was just the lose flesh interested. 13 stitches later it was all good.

 

But I had to literally argue with the nurse pushing a knee brace, basically a square of foam with plastic belt straps at the tune of $240, to keep me from bending the knee. After all, I had insurance. I told her to give me a damn release form to sign, but I wouldn't take the stupid contraption.

 

She didn't think it was funny when I asked her if the excruciating pain wouldn't be remainder enough not to bend the leg.

[upflying]

Reminds me of the whiplash injuries some MVA occupants suffer. They are prescribed a foam neck brace..also known as a "money belt".

[Ken H.]

I am relucatant to paint all such companies with such a broad stroke, but I am convinced that many many millions of our limited Medicare dollars have been wasted on DME that is neither wanted or needed.

Medicine for profit, it’s a US American core tenant. What else would you expect?

 

That being said, its easy to get jaded by the fraud and loose sight of the good the programs do too.

 

[Ken H.]

Why can't there be some sort of form "sign off" by the patient for these services, stating they've requested this?

Ha! Ever been to a nursing home? 80% of the residents will sign whatever is put in front of them without a clue. Heck my care facility bed ridden mother would sign for vacuum erection system without a second thought if told to by the nice lady that brings her jello every day.

[bakerzdosen]

Ken,

 

I really shouldn't be laughing at the expense of your "bed ridden mother" but....

 

[Whip]

I wish some one would bring me Jello.

[JayW]

...its easy to get jaded by the fraud and loose sight of the good the programs do too.

 

My beef is not with the programs, it is with the suppliers who take advantage of them. I have come to detest the faxes that come to me every day claiming that my patient has requested this or that, even though we had never discussed it. The companies I mentioned are utterly untrustworthy and I have to verify every claim they make. To do this wastes a lot of time and resources. Local suppliers can usually provide higher quality equipment with better service at the same Medicare-reimbursed cost. If there is a problem, then they are just down the street and are usually anxious to make it right.

 

So here is my proposed solution: Medicare should require that DME be prescribed just like a prescription drug for those who are not paying out-of-pocket. Suppliers who wish to bill Medicare for equipment cannot do anything without a prescription from the patient's doctor specifying the needed equipment. This requirement would have several benefits:

1. It gets me in the loop early so that we can talk about the issue. If a patient clearly does not qualify for a peice of equipment then the process stops right there.

2. It keeps companies from fabricating requests because they would have to refer the patient to their doctor for a prescription before they contacted me themselves.

3. I could warn the patient of the "side effects" of the equipment, such as the increased weakness and weight gain that typically occurs after one gets a scooter.

4. I could recommend a particular supplier, or warn patients away from others. However, like a prescription, they could still get it filled wherever they wish.

5. My solution would not prevent a patient from paying for equipment on their own if they still want it.

6. It would keep me from always looking like the bad guy when the supplier tells the patient that, "Your doctor wouldn't approve it", when in truth they simply don't qualify for it. Medicare has very strict criteria for what they will and will not pay for, but companies like the Scooter Store routinely suggest to patients that they will qualify without properly screening them. This may tempt the doctor to exaggerate the need on the order sheet since that is easier than denying an expectant patient. I have lost patients who got angry at me for not signing an order for a scooter.

 

So what do you think? Are there any Congressmen that frequent this site?

 

Jay

[Quinn]

Is this the medicare fraud that Obama says he will stop and use the money to pay for his health care programs?

 

My experience with medicare so far has been with my mother. When she was dying of cancer, she went to the hospital for tests. After a certain number of days, she was no better and they had run out of tests to give her. Seems she had to keep getting tests and having consultations to justify being in the hospital. She then went to a nursing home for physical therapy; again for a certain number of days. In talking to them, it was all based on how long medicare would pay for things. At the end of that certain number of days, the choices were that either we could continue to pay for the nursing home (there was never any physical therapy of course) or she could get worse and go back to the hospital and receive further tests for another round of a certain number of days. She went back to the hospital and died before her medicare length of stay was used up at the nursing home and before we could get her into hospise.

 

I've seen the same thing happen to the parents of two of my friends. They didn't get the care they needed, they got the care that the system was set up to deliver.

 

My point, in my rant, is that seniors are already experiencing how the government sees health care. It's little more than a mess of flow charts to determine appropriate care. One size fits all as you flow through the appropriate chart.

 

---

 

 

[TyTass]

Many people (other than me) would look at this and it would confirm for them that you, the greedy doctor, are just trying to enure you get brought into the loop solely to ensure you can charge for an extra visit or more time.

 

of course, I don't view it that way. In fact, I applaud your insistance that you act in an ethical manner and ensure that others who use your services act in an ethical manner, as much as possible within your control.

 

However, deep down I believe you are just treating the symptoms ... i.e., unethical people taking advantage of any program/system ... the same symptoms that are almost sure to increase exponentially as more and more of your profession fall under government management.

[TyTass]

I am relucatant to paint all such companies with such a broad stroke, but I am convinced that many many millions of our limited Medicare dollars have been wasted on DME that is neither wanted or needed.

Medicine for profit, it’s a US American core tenant. What else would you expect?

 

That being said, its easy to get jaded by the fraud and loose sight of the good the programs do too.

Ken, actually you sound jaded, to me. This country has a rich (pun intended) history of exceptional advancements in medical care ... and yes for profit (God forbid! ). Have there been abuses there. Certainly! Are there going to be abuses in National Medical care. Abso-frigging-lutely! The sense of entitlement in this country has just hit record proportion. The concept of healthcare being a right isn't new. It's just still incorrect.

[steve.foote]

I think the solution is to just have one huge organization responsible for all billing, payments, and processing of pharmacological and durable medical supplies and equipment; aw heck, why not the whole shooting match?

 

That way, all this fraud would just stop cold.

 

Just look at the job as it is being done today.

 

Think of the efficiency we could achieve.

 

 

Oh, you devil dog, you. You sly, sly devil.

 

[steve.foote]

There are a lot of really good comments in this thread.

 

Jay, you have good reason to be irked, but you're pissing in the wind. Healthcare fraud only penalizes those who pay into it. The perp, the recipient, they get off scott free. If unchecked, the fraud will increase until it eventually reaches the point where it makes it to the radar screen of law enforcement, which can take quite a lot of time and effort. This is nothing new.

 

Here is the crux of the biscuit. If the government puts a pot of taxpayer's money on the street (Medicare, Medicaid, mortgage assistance, research grants, etc.) someone is going to put their hand in that pot and help themselves. It's just going to happen. Expecting otherwise is naive.

 

Accountability is the only true defense against fraud, waste and abuse. And, the only way to accomplish that is to cut out the thick layer of government bureaucracy which stands between the provider and the consumer. If the individual is responsible for the cost of what they are receiving, they will work harder than anyone else to make sure it’s correct. Just look at how closely people scrutinize their cellphone bills.

 

Since taxpayer's are picking up the tab, only those who pay taxes have an incentive to ensure the costs are honest and accurate. I’m afraid that, like you, we’re all pissing in the wind. As long as the ‘something for nothing’ mentality continues to be advocated, efforts by good people to combat fraud, waste, and abuse will be mostly a waste of one's valuable time.

 

[Selden]

My experience with medicare so far has been with my mother. When she was dying of cancer, she went to the hospital for tests. After a certain number of days, she was no better and they had run out of tests to give her.

Seems she had to keep getting tests and having consultations to justify being in the hospital. She then went to a nursing home for physical therapy; again for a certain number of days. In talking to them, it was all based on how long medicare would pay for things. At the end of that certain number of days, the choices were that either we could continue to pay for the nursing home (there was never any physical therapy of course) or she could get worse and go back to the hospital and receive further tests for another round of a certain number of days. She went back to the hospital and died before her medicare length of stay was used up at the nursing home and before we could get her into hospise.

It's very difficult to write this online without risk of being misunderstood, or seeming callous, but if your mother was dying of cancer, and Medicare didn't exist, and you were paying for hospitalizations and testing out of your own pocket, would you have continued to do so?

 

We live, we age, we weaken, and eventually we die. To an unfortunate degree, the medicalization of aging prolongs death, not life. I say this from personal experience, as my 88-year old father-in-law has been hospitalized repeatedly over the past 3 years, and was in a drug-induced coma on a ventilator for 10 days last spring. Most of his social life consists of going to doctors at the VA hospital. On one such visit, a doctor told him, "There is nothing we can do to fix what's wrong with you, which is old age."

 

I would not want to "live" in this manner, and I hope that long before I reach his state, I will have the courage not to. But, I can't be sure because I'm not there.

 

Christopher Buckley (son of William F.) wrote a very dark book called Boomsday, with the Swiftian idea that the SS/Medicare budget problem could be eliminated if each of us would sign up for a fixed termination date, in exchange for tax breaks.

 

[JayW]

Many people (other than me) would look at this and it would confirm for them that you, the greedy doctor, are just trying to enure you get brought into the loop solely to ensure you can charge for an extra visit or more time...

 

Craig, I can see how some might interpret my comments this way. The truth is that I don't need to look for ways to generate more visits or patient time. If I want to do that, all I have to do is open up slots in my schedule and it gets full. This is not because I am anybody special, but rather due to the national shortage of primary care physicians. Two internists left my own practice last year and we have not been able to recruit repacements. Many physicians have had to stop accepting new patients, and residents complain that they cannot find a local doctor who can see them.

 

Jay

[Polo]

I would not want to "live" in this manner, and I hope that long before I reach his state, I will have the courage not to. But, I can't be sure because I'm not there.

 

Christopher Buckley (son of William F.) wrote a very dark book called Boomsday, with the Swiftian idea that the SS/Medicare budget problem could be eliminated if each of us would sign up for a fixed termination date, in exchange for tax breaks.

 

The answer to this is a Living Will.

 

The first confrontation I had with this reality was when I my mother was refused Dialysis treatment. We were told simply that she wasn't a viable candidate because of her age. This was at the Mexican Institute of Social Security in Mexico. Yes, socialized medicine. Their point was simply we can do the treatment, but when we're done she still will be 88 years old. We can alleviate her discomfort, but we cannot make her kidneys young again. We consulted a private physician who told us the same, telling us that we could pay for the treatment out of pocket, and make her just OK for a few months, or we could engage another mediation treatment and make her OK for as many months.

 

In the end, she decided that she wanted to be comfortable, and stay away from hospitals.

 

An uncle of mine was dragged thru a painful and uncomfortable series of treatments after being diagnosed with an inoperable cancerous brain tumor. The doctors convinced his family to try everything; make every effort possible... while there was any insurance money to be spent. The last time I saw him he just looked at me with empty eyes. Talking with him, he acknowledged to know he was dead, but was willing to go thru this hell just so his wife and children could feel good.

 

My wife and children know my wishes, I have written them down. If I won't be close to normal, - normalcy given by the age when this happens - I want the least inconvenient approach for everybody involved, be it pulling the plug, or just manage the acquiescence. I don't want the last penny I might have, going towards an effort to prolong my agony under the pretext of prolonging my life.

 

On a vary personal level, I have also included the way to dispose of the remains. From wherever I drop, meet legal requirements, cremate the body and flush it down the toilet. My daughter suggested to drop the ashes from a bike on the 3's, that sounds good too.

[Quinn]

Seldon, I do agree with you on serveral levels. It sure would help my retirement planning if I had an expiration date stamped on my forehead. That said, I'm already in the shape of which I said as a young man that I would go ahead and put myself out of my misery. Now it doesn't seem so bad. Now I realize that I don't know how I'll feel when I'm bedridden and totally dependent on others. Like your father-in-law, my father took years to die after his quality of life reached that level. He was ready to go, but medical science kept him propped up. When he passed, it was with a sense of relief for him as well as my mother.

 

My complaint with my mother's experience on the Medicare death treadmill was that she kept being subjected to tests and consultations when they all knew that there was nothing left to do. I remember asking the doctor how much longer she had and he said, "Thursday." But needing to justify her staying in the hospital, they had to schedule MRIs, blood tests, and other pointless proceedures that were torture to her in her condition. At first I thought it was just the hospital's way of running up the bill, but later realized that it was necessary for them to justify the hospital stay to Medicare. We were never told about hospise as an alternative. Hospise was not on the treadmill.

 

---

 

 

[Twisties]

I would not want to "live" in this manner, and I hope that long before I reach his state, I will have the courage not to. But, I can't be sure because I'm not there.

 

Christopher Buckley (son of William F.) wrote a very dark book called Boomsday, with the Swiftian idea that the SS/Medicare budget problem could be eliminated if each of us would sign up for a fixed termination date, in exchange for tax breaks.

 

The answer to this is a Living Will.

 

The first confrontation I had with this reality was when I my mother was refused Dialysis treatment. We were told simply that she wasn't a viable candidate because of her age. This was at the Mexican Institute of Social Security in Mexico. Yes, socialized medicine. Their point was simply we can do the treatment, but when we're done she still will be 88 years old. We can alleviate her discomfort, but we cannot make her kidneys young again. We consulted a private physician who told us the same, telling us that we could pay for the treatment out of pocket, and make her just OK for a few months, or we could engage another mediation treatment and make her OK for as many months.

 

In the end, she decided that she wanted to be comfortable, and stay away from hospitals.

 

An uncle of mine was dragged thru a painful and uncomfortable series of treatments after being diagnosed with an inoperable cancerous brain tumor. The doctors convinced his family to try everything; make every effort possible... while there was any insurance money to be spent. The last time I saw him he just looked at me with empty eyes. Talking with him, he acknowledged to know he was dead, but was willing to go thru this hell just so his wife and children could feel good.

 

My wife and children know my wishes, I have written them down. If I won't be close to normal, - normalcy given by the age when this happens - I want the least inconvenient approach for everybody involved, be it pulling the plug, or just manage the acquiescence. I don't want the last penny I might have, going towards an effort to prolong my agony under the pretext of prolonging my life.

 

On a vary personal level, I have also included the way to dispose of the remains. From wherever I drop, meet legal requirements, cremate the body and flush it down the toilet. My daughter suggested to drop the ashes from a bike on the 3's, that sounds good too.

 

Except you live in Texas, where your doctor can choose to ignore your wishes and subject you to treatment anyway.

[Ken H.]

Ken, actually you sound jaded, to me. This country has a rich (pun intended) history of exceptional advancements in medical care ... and yes for profit (God forbid! ). Have there been abuses there. Certainly! Are there going to be abuses in National Medical care. Abso-frigging-lutely! The sense of entitlement in this country has just hit record proportion. The concept of healthcare being a right isn't new.

Healthcare isn’t a ‘right’ per say, but it is a key component of a successful society/country. A health populous over all, over the long run, does better at things than a less healthy one. Countries that recognize the fact that the cost of keeping people healthy is far less than the loss it they are less so; have a competitive edge. The US healthcare system is the most expensive per capita by far, yet in most every measurable category it trails the rest of the western (and some parts of the eastern) world.

 

Yes I’m jaded about the US healthcare system, it’s one of the reasons we left. But the US takes a short-term, make a buck off the sick guy approach, and IMHO it’s one of the (many) reasons the US has lost it’s global competitive edge. But alas, I don’t see the US ever fixing the issue, there’s no ‘good of the many’ think left in that country. Just an ongoing continuation of the ‘get mine, the other guy be damned’ approach to most everything. But I’ve gotten to the, ‘you made your bed, now go sleep in it’, point. Jaded? Yup!

 

[Polo]

Except you live in Texas, where your doctor can choose to ignore your wishes and subject you to treatment anyway.

 

Who knows where I'll be if and when this may become applicable, why sweat it? It's a guideline.

 

[TyTass]

Many people (other than me) would look at this and it would confirm for them that you, the greedy doctor, are just trying to enure you get brought into the loop solely to ensure you can charge for an extra visit or more time...

 

Craig, I can see how some might interpret my comments this way. The truth is that I don't need to look for ways to generate more visits or patient time. If I want to do that, all I have to do is open up slots in my schedule and it gets full. This is not because I am anybody special, but rather due to the national shortage of primary care physicians. Two internists left my own practice last year and we have not been able to recruit repacements. Many physicians have had to stop accepting new patients, and residents complain that they cannot find a local doctor who can see them.

 

Jay

I have no doubt whatsoever you know what you're talking about. And your point supports my beliefs/opinions/experience. I too have a hard time finding primary care physicians taking new patients in my area - so I see a PA. Enacting programs and laws does not equal more available healthcare (i.e., more doctors).

[Ken H.]

...its easy to get jaded by the fraud and loose sight of the good the programs do too.

My beef is not with the programs, it is with the suppliers who take advantage of them.

Oh I understand, it is infuriating. I just get irritated by those who point to abuses of the system (any system) and use that as justification that the who system (e.g. – Medicaid) should be done way with. I’m not saying you’re saying that, because you haven’t in this thread, but the view/point is common. Or as evidence to why some other program can’t be made to work. There are abuses of everything. As long as the subject is profit driven people will figure out a way to cheat to increase their personal profit. The key question in my mind is - does the good done outweigh the bad? And for the vast majority of these programs I think – yes.

[BFish]

Check this fraud case out. largest medical group in melbourne, fl. not a client of mine, but i have some of the docs as clients (none of the oncology folks).

 

couple days later it was reported that no criminal charges appear forthcoming, which baffles me.

 

 

Fraud

[JayW]

...The answer to this is a Living Will...

 

Living Wills certainly can be helpful, but they can be hard to apply a specific illness and situation.

 

For patients who cannot speak for themselves, I find it more helpful if there is a Healthcare POA to speak for him/her. Ideally this is a committed spouse or relative who knows the patient well and has a good idea of what he/she would want under the circumstances based on previous discussions they had before the illness.

 

The attending physician should take a "head coach" role to see to it that tests and/or consultations are done when appropriate, and are not done when not appropriate. We get no kickback from the hospital for ordering tests, and my hospital income is not affected by tests. I do not order tests only to justify keeping a patient in the hospital, nor has any hospital ever pressured me to do so. When a patient has reached maximal hospital benefit, then they should be discharged to home or a lower level-of-care facility where their needs can be met. Every hospital has discharge planners whose job it is to help arrange for appropriate post-hospital care under guidance from the attending.

 

Jay

[skinny_tom (aka boney)]

There are a lot of really good comments in this thread.

 

Jay, you have good reason to be irked, but you're pissing in the wind. Healthcare fraud only penalizes those who pay into it. The perp, the recipient, they get off scott free. If unchecked, the fraud will increase until it eventually reaches the point where it makes it to the radar screen of law enforcement, which can take quite a lot of time and effort. This is nothing new.

 

Here is the crux of the biscuit. If the government puts a pot of taxpayer's money on the street (Medicare, Medicaid, mortgage assistance, research grants, etc.) someone is going to put their hand in that pot and help themselves. It's just going to happen. Expecting otherwise is naive.

 

Accountability is the only true defense against fraud, waste and abuse. And, the only way to accomplish that is to cut out the thick layer of government bureaucracy which stands between the provider and the consumer. If the individual is responsible for the cost of what they are receiving, they will work harder than anyone else to make sure it’s correct. Just look at how closely people scrutinize their cellphone bills.

 

Since taxpayer's are picking up the tab, only those who pay taxes have an incentive to ensure the costs are honest and accurate. I’m afraid that, like you, we’re all pissing in the wind. As long as the ‘something for nothing’ mentality continues to be advocated, efforts by good people to combat fraud, waste, and abuse will be mostly a waste of one's valuable time.

 

My question is this; Which part of the biscuit is the crux?

 

I don't really have anything to contribute, but your points are well made.

[TyTass]

But alas, I don’t see the US ever fixing the issue, there’s no ‘good of the many’ think left in that country. Just an ongoing continuation of the ‘get mine, the other guy be damned’ approach to most everything. But I’ve gotten to the, ‘you made your bed, now go sleep in it’, point. Jaded? Yup!

Well, we do agree some points. I too despair the US fixing our problem. But you and I differ on what is the causal problem. I agree the problem is indeed greed, but we disagree as to the nature of that greed. Another point we seem to agree on is that the US actually hasn't yet finished making the bed. It's being made and remade every freakin' ridiculous approval of additional deficit spending after the next.

 

On a somewhat silly note, I could probably agrue that I have scarcely been a party to making this bed. I draw little from the Fed budget that hasn't been purchased by my efforts. I pay off my debts. I've never declared bankruptcy. I've spent most of my life not making much money, but now later in life, I pay in a whole grunch more money comparatively. However, all that said ... I admit I am part of the problem.

 

I am guilty because at leasst a couple of people I have voted for in my lifetime have supported deficit spending (to my horror and shame). In fact, I can say that although I have a really good track record of voting for folks who never get in office at all - nor even had a chance, ALL of those that I've voted for and won in the end supported deficit spending! Ach!

 

So, greed, Ken? Yes indeed! But greed is a double-edged razor that cuts two ways. It's not just about the big bad businessman who lines his pockets unethically and feels entitled to do so (your favorite stereotype). It's also when a person, like you for example, makes a legal requirement that the money and or efforts of others are subject to that persons "needs." That is no less greedy. It is also counter to your stated ideals that the need of the many ... yada, yada, yada!

 

Being able-bodied people, you and I claiming that those "needs" are actually for the good of everyone else in the country is not only ridiculous, it is nothing more than us engaging in an egocentric fantasy to cover our own form of greed. If you don't agree with that conclusion, try this experiement ... say the following out loud a few times ... "my health is for the good of the nation, my health is for the good of the nation!"

 

It sounds preposterous simply because it is. It sounds egocentric simply because it is. So please let's dispense with the pretense that you are somehow operating from the high ground in this discussion. Your social/moral views are in conflict with the end you are not only hoping to achieve but would be willing to achieve.

 

Oh, and also ... as able-bodied citizens, your health and mine are indeed our own responsibility. There's nothing cut-throat or dog-eat-dog about that. That is accountability and responsibility, personal/national traits that can easily be argued is declining with each passing law/year.

 

Back to the greed issue ... through all this, I think the most astounding greed we are witnessing is that we (meaning many nations today) are so freakin' greedy that we are quite so apparently willing to strap our children/posterity with our bills (deficits of unrivaled proportions) for these "needs," just so we can have what we want ... and have it right freakin' now!

[CoarsegoldKid]

Yes, please don't paint ALL DME(Durable Medical Equipment) suppliers with the color fraud. Prosthetists and Orthotists have all been bundled into the category of DME by Medicare regulators, and do not like it by the way, because a prosthetic leg, arm, hand or foot, braces for stroke victims, custom shoes for diabetics and a host of other items are durable.

 

So here is my proposed solution: Medicare should require that DME be prescribed just like a prescription drug for those who are not paying out-of-pocket. Suppliers who wish to bill Medicare for equipment cannot do anything without a prescription from the patient's doctor specifying the needed equipment.

 

Already a requirement for certified Prosthetists and Orthotists.

[JayW]

Yes, please don't paint ALL DME(Durable Medical Equipment) suppliers with the color fraud...

 

No, of course not. I hope I made that clear. I am particularly supportive of the local independent businesses that supply DME.

 

Jay

[steve.foote]

My question is this; Which part of the biscuit is the crux?

 

Boney, to truely understand the crux of the biscuit, one must study Strange Rock 401 under the tutelage of Professor Frank Zappa.

 

[Boone60]

Thanks for doing this Jay, it's appreciated.

[Kathy R]

Very worthwhile post and discussion. Thank you all, for the education.

[Matts_12GS]

My question is this; Which part of the biscuit is the crux?

 

Boney, to truely understand the crux of the biscuit, one must study Strange Rock 401 under the tutelage of Professor Frank Zappa.

 

The Crux of the biscuit? Is the apostrophe!

[JayW]

Thanks for all the supportive words. I suspect very few non-health care workers appreciate how commonly this kind of fraud and abuse occurs, which is one reason I decided to start this thread. In the end, health insurance fraud costs all of us, and I am glad for the opportunity to share my experiences via this forum. Your responses encourage me to continue to fight the good fight.

 

Jay

[Matts_12GS]

Well, we do agree some points....

 

Well said Craig!

 

I agree with your points about greed especially when you speak of the "egocentric fantasy to cover our own form of greed..."

 

I have a lot more to say, but the deaf ears it'd fall on aren't worth the vacation I'd get...

[steve.foote]

My question is this; Which part of the biscuit is the crux?

 

Boney, to truely understand the crux of the biscuit, one must study Strange Rock 401 under the tutelage of Professor Frank Zappa.

 

The Crux of the biscuit? Is the apostrophe!

 

We have a winner!!!