September 14, 2009, 7:53 am

And Then There’s Fraud…

beforehand lotionWell, I lead a double life but it isn’t out dancing in formal wear!

“There is time for only fleeting thoughts about that dance you’ll attend during off duty hours.”

There isn’t even time for that.

Besides, who attends a dance during on duty hours?

Well, I guess the most important thing is that our hands are “soft, smooth and free from redness” because “your patients like it and your date expects it”.

Oh yeah?

The day they use a hand sanitizer thirty times in a shift and wash their hands another twenty, they can talk to me about soft hands.


OffwhitelogoDon’t forget Change of Shift is up this Thursday at Medic 999. Mark is awaiting your submissions.

Use Blog Carnival or send them to mglencorse at yahoo dot co dot uk”.

Many thanks to Mark for hosting the nurses this edition!


My husband won’t watch football with me because I tend to get hyped up and throw things at the TV when I get upset.

That explains why there were Notre Dame pom poms and a Cleveland Browns jersey at the base of the set this weekend.

I also like to talk back at the President when he is speaking on TV. Usually it’s things like “Say WHAT?” or “Give me a break!” “Get. A. Clue!” is usually a good one. This last speech, the one to Congress about health care, was no exception. My first comment came a bit into the speech when I noted a few times that “I haven’t heard a single thing I disagree with yet” and “he’s right on that point”.

I was afraid hubby was going to need smelling salts.

But I’m like, “let’s hear how he is going to pay for this…let’s hear him out”.

And then I heard it.

And then he lost me.


There were two comments that I could not let go. I looked them up in the text of the speech to make sure I had heard them correctly.

“…we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse.”

“The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud…”

Hundreds of billions of dollars? Billions? With a capital “B”?

Waste. Abuse. Fraud.

This means that in order to pay to the proposed health care reform, we have to find enough waste, abuse and fraud to cover expenses.


But I have some questions.

What is the definition of “waste”? To the extent that “waste” means inefficient bureaucratic practices that use up monetary resources, I can get on board with that.

Abuse? What kind of abuse? Using the system inefficiently, like calling an ambulance for a stubbed toe? Remember, the President is using the term “abuse” to represent a potential income stream for the new system, so it would have to encompass behaviors that spend money that should not be spent. Money is spent on patient care, so is he talking about patients abusing the system?

And then there’s fraud…

That’s a crime, folks.

Hundreds of billions of dollars in waste and fraud?

The President must think that there are an awful lot of criminals in the health care system.

So what’s my point?


My point is this: funding for the new proposed health care system (see “most of this plan…”, above) is based on finding waste, abuse and fraud.

What happens when all the waste is taken out, all the abusers are stopped, the fraudsters jailed and the system needs more funding? Does that not make it imperative that we keep finding waste and abuse and fraud? Does that not mean that what constitutes waste, abuse and fraud must be constantly expanded to make up for rising costs?

This can’t be good.

I am in total agreement that our system can be streamlined, big time.

And maybe we could find enough money in waste, abuse and fraud to make it pay for itself, but I doubt it.

If we could do that, wouldn’t we have done it already with Medicaid and Medicare? The budgets for both are getting slashed on a regular basis. Drop the waste, abuse and fraud in those programs and then come back and tell me how much better their budgets are.

If we can’t do it in an existing government-provided system, how on earth do you expect us to believe it can be done on a larger scale?




  • Amy

    September 14, 2009 at 10:05 am
    read this article. this is the government run system…that is what worries me. The things that the government runs…medicare, medicaid, social security, post ofice, and amtrack..they are all BROKE…
    I do think our health care system needs work…its a mess…but I am not sure how much I was the federal government doing it

  • Rosie

    September 14, 2009 at 2:50 pm

    And why not FIX the broke systems we already have–instead of creating another brand new system that overwhelms our already overwhelmed facilites, gives us so many patients that we are dangerously understaffed, and ventures into dangerous waters of making decisions for us?

    I grew up poor. I believe we do need to find a way to provide health coverage for everyone. My heart breaks every time I hear of someone, especially a vulnerable member of the population, who can’t afford necessary medical treatment and preventive healthcare.

    But when I’m 65 and my body finds it harder to keep going as autoimmune conditions advance, I don’t want someone telling me that I can’t have the latest and greatest REASONABLE treatment because I won’t live long enough to justify the cost. If you think I’m feisty now, wait until I’m 65! –and even if my body is functioning less than optimally, my mind will still have plenty of contributions to offer society.

    We’re wading into dangerous waters…

    Whatever side of the debate you’re on, PLEASE PLEASE PLEASE make your voice heard and WRITE TO YOUR ELECTED REPRESENTATIVES. Let them know what you want/don’t want.

    And nurses, please read the entire text of the proposed legislation. I’ve read it, and it scares me. I just about had a heart attack when I read today that the ANA backs the initiative as it currently stands.

  • Ken O

    September 15, 2009 at 12:58 am

    Case in point; an American mate was telling me how he’d just been billed over $100 retail for a course of Tamiflu; the wholesale cost of same in the UK is $16ish (and that’s close to what we’d pay). Anyone else think I may have found a major cash leak in your system?

    Incidentally, I tend to yell at politicians on the Tv too!

  • Rosie

    September 15, 2009 at 12:38 pm

    $100 for a few days of Tamilflu is what happens when Congress is in bed with Big Pharma…

  • SkippyMom

    September 16, 2009 at 4:40 am

    An example of abuse – I breastfed all 4 of my kids, starting immediately after birth. Somehow each and everyone of my insurance companies were billed [and paid] for post birth pain killers, because I am sure the hospital just “knew” I needed them.

    Unfortunately – I never took one single pain killer as I was a nursing mom. All four insurance companies ended up being reimbursed for the charge – but to happen ALL four times?

    Once is a mistake, twice may be an oops, but the third and forth times were absolutely abuse of the insurance system to pay for something the insurance companies assumed I had taken.

    And everyone wonders why premiums are so high to have health insurance? I haven’t since my last child was born 11 years ago.

  • SkippyMom

    September 16, 2009 at 4:46 am

    **fourth time [and I was the one that caught the mistakes in billing and had to notify the hospitals’ billing offices to refute the charges. My insurance companies seemed to be happy to pay and be done with it.]

  • Liberal

    September 16, 2009 at 9:30 am

    I just want to add comment which does not have to be for or against. One of my patients had an insurance, job , and a house before having heart attack and everything after that. well, he lost his job because he was a driver, he lost his insurance because he does not work, he lost his house because he does not have income … and he is still sick.. so here goes your saving on the plate… here goes your dreams .. here goes control of “government” – hmm this is still just a debate right? so who is responsible for this ? Should we all wait to get sick and loose everything we have before we can get (AGAIN) something that is controlled by government.. I feel in loop here… Have a healthy day!

  • kirst

    September 16, 2009 at 1:42 pm

    Sorry I cannot comment on your Health care system, it confuses me. But hello!! I thought the bottle was a pump version of Thrush Cream , had to re read he Ad, thinking why are they rubbing thrush cream in to there hands for a date, safe sex or what?

  • AlisonH

    September 16, 2009 at 4:31 pm

    The biggest wastes are the megamillions that have been lost to actual healthcare since the Blue Crosses, particularly in and starting with California, were allowed to go to for-profit. Require all health insurance companies to be non-profit entities–as most of them used to be and some still are–would make those $52 million salary-and-benefits packages go poof.

    That said, on a smaller scale, the company that my ileostomy supplies come from charges, on paper, about $860/month. If I as their already-a-customer buy the stuff out of pocket, they give me a 20% discount. Blue Cross only pays about a third, and they take that and run. So why can’t I get the BC rate?

  • The Daily Reviewer

    September 16, 2009 at 6:11 pm


    Congratulations! Your readers have submitted and voted for your blog at The Daily Reviewer. We compiled an exclusive list of the Top 100 nursing Blogs, and we are glad to let you know that your blog was included! You can see it at

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    Selection Committee President
    The Daily Reviewer

  • NurseJoc

    September 21, 2009 at 8:28 pm

    Fudging an insurance application to make sure that a patient can get covered is fraud and I’m guessing that isn’t a very unheard of issue?

    I just have my fingers crossed that no one should have to file for bankruptcy or spend more than a single year paying off a medical bill. I’m bias because I’ve been blessed to never be in that situation.

    Anyway, thank you for your awesome Change of Shift contribution over at MedicBlogg999 — awesome stuff 😀

  • Ken O

    September 22, 2009 at 12:01 am

    NurseJoc, I’m presuming that US law is similar to British when it comes to taking out insurance.
    If it is, then the insurance policy is termed a “contract of great good faith”, and it is presumed that you have disclosed all relevant facts which might affect the insurer’s decision on whether or not to offer a policy, and set the level of premiums. If you have not done so, then it is not normally treated as fraud, but does allow the insurer to cancel the policy and any payouts that might be due, and to keep the premiums.

  • Margaret

    September 28, 2009 at 11:53 am

    Healthcare coverage should not be related to a job, unless the company self-insures ( The idea that you need to be a member of a ‘group’ before you can get affordable healthcare coverage is part of the problem. Insurance companies should calculate the risk across their customers and not a group of employees of a single company. A person should be getting charged the same for coverage regardless of who is paying for it.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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