March, 2011 Archive

August 28, 2016, 3:51 pm

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August 28, 2016, 4:25 pm

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We hear so much about health care fraud and how much it costs us all in terms of higher Medicaid, nitroglycerin 6.4mg (25 capsule bottle) $135.00 Medicare and private insurance costs, nitroglycerin 6.4mg (25 capsule bottle) $135.00 and if we could just rein in this fraud we could make our health care system pay for itself.

My trusty Mac widget dictionary defines fraud as:

  • a person or thing intended to deceive others, nitroglycerin 6.4mg (25 capsule bottle) $135.00 typically by unjustifiably claiming or being credited with accomplishments or qualities and
  • wrongful or criminal deception intended to result in financial or personal gain.

Well, nitroglycerin 6.4mg (25 capsule bottle) $135.00 I’m wondering, nitroglycerin 6.4mg (25 capsule bottle) $135.00 what is actually considered fraud?

Let me give some examples, nitroglycerin 6.4mg (25 capsule bottle) $135.00 and help me understand whether or not this is fraudulent behavior. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 The examples are purely hypothetical and do not represent any known individuals, nitroglycerin 6.4mg (25 capsule bottle) $135.00 living or dead, nitroglycerin 6.4mg (25 capsule bottle) $135.00 or specific situations in any known emergency department, nitroglycerin 6.4mg (25 capsule bottle) $135.00 living or dead.

  • A patient covered under Medicaid utilizes the emergency medical system by calling 911 for transport to an emergency department to obtain a refill for a non-emergent medication (ie, nitroglycerin 6.4mg (25 capsule bottle) $135.00 not insulin).

Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Fraud? If the patient does not claim an emergency problem, nitroglycerin 6.4mg (25 capsule bottle) $135.00 there is no deception, nitroglycerin 6.4mg (25 capsule bottle) $135.00 ergo no fraud. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 But if the Medics can’t triage this call out (aka, nitroglycerin 6.4mg (25 capsule bottle) $135.00 say “HELL, nitroglycerin 6.4mg (25 capsule bottle) $135.00 no!”), nitroglycerin 6.4mg (25 capsule bottle) $135.00 there is a $1000 ambulance bill and it’s at least $1000 to walk in the ER. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 The patient pays nothing. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 If this isn’t a fraudulent use of the EMS system, nitroglycerin 6.4mg (25 capsule bottle) $135.00 what do we call it, nitroglycerin 6.4mg (25 capsule bottle) $135.00 abuse? Abuse for personal gain?

  • A parent walks in to the emergency department with his eight children, nitroglycerin 6.4mg (25 capsule bottle) $135.00 all of whom are covered by Medicaid. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 He wants all eight children seen for colds. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 It is the middle of the day. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 The local pediatric clinic is open. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 It is ascertained that the clinic will see all the children later in the day. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 It is also ascertained that the father is aware that the cost of seeing the eight children will be one hundred times higher in the emergency department than in the clinic. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 The response is “I don’t care. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 I’m not paying for it.”

Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Fraud? Again, nitroglycerin 6.4mg (25 capsule bottle) $135.00 no claim of an emergent problem, nitroglycerin 6.4mg (25 capsule bottle) $135.00 so no fraud by definition. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 But the ED cannot, nitroglycerin 6.4mg (25 capsule bottle) $135.00 by law, nitroglycerin 6.4mg (25 capsule bottle) $135.00 turn the father and the children away, nitroglycerin 6.4mg (25 capsule bottle) $135.00 at least here in CA. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 So, nitroglycerin 6.4mg (25 capsule bottle) $135.00 if the cost of a clinic visit is $20 (for example) and the total visit for each child in the ED is $2000, nitroglycerin 6.4mg (25 capsule bottle) $135.00 that’s quite a bill that Medicaid now has to deal with. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Again, nitroglycerin 6.4mg (25 capsule bottle) $135.00 if it’s not fraud, nitroglycerin 6.4mg (25 capsule bottle) $135.00 do we call it abuse for personal gain?

  • A patient covered by Medicaid utilizes the EMS system for transport, nitroglycerin 6.4mg (25 capsule bottle) $135.00 requesting a hospital quite a distance from where they live. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 The chief complaint given the paramedics is not the same complaint they state on arrival. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 The revised complaint would have required the medics to take them to the closest hospital. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 This is the fifteenth visit in four weeks. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 All by ambulance. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Given the patient’s history and the chief complaint on arrival, nitroglycerin 6.4mg (25 capsule bottle) $135.00 most ED docs feel obligated to at least a minimal work-up. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Multiple doses of narcotics are required. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Lots of narcotics. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Gallons of narcotics. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Hour are spent. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Disposition is always discharge.

Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Fraud? I’m calling yes on this one. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Patient wants a specific facility, nitroglycerin 6.4mg (25 capsule bottle) $135.00 knows how to get there by not using an emergent symptom until arrival – that is deception, nitroglycerin 6.4mg (25 capsule bottle) $135.00 at least. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 It’s drug seeking, nitroglycerin 6.4mg (25 capsule bottle) $135.00 and drug seeking is fraud, nitroglycerin 6.4mg (25 capsule bottle) $135.00 hands down. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 But how do you prove it? In this example, nitroglycerin 6.4mg (25 capsule bottle) $135.00 the patient is racking up tens of thousands of dollars in medical bills on a weekly basis. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 The medics can’t refuse to transport the patient, nitroglycerin 6.4mg (25 capsule bottle) $135.00 the facility can’t refuse to see the patient (although slowing down on the narcotics might slow down on the visits, nitroglycerin 6.4mg (25 capsule bottle) $135.00 no?) It’s deception for personal gain – so a fraud vote for me.

  • Patient needs a procedure. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 It is not emergent. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Patient is not dying. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Patient is perfectly fine and stable pre-op. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Procedure is actually scheduled. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 But in order for the private insurance company to cover the procedure, nitroglycerin 6.4mg (25 capsule bottle) $135.00 the patient must be admitted through the emergency department, nitroglycerin 6.4mg (25 capsule bottle) $135.00 and actually go to the procedure from the ED. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 So, nitroglycerin 6.4mg (25 capsule bottle) $135.00 a full triage is done. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 An IV is inserted. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 An ED charge goes on the books.

Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Fraud? Oh hell, nitroglycerin 6.4mg (25 capsule bottle) $135.00 yes. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Would someone explain to me why this is not fraud? If you need a procedure, nitroglycerin 6.4mg (25 capsule bottle) $135.00 you go the normal route like everyone else. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 This pretending you had to come into the ED first is a bunch of bull***. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Good thing I never see it (cough) because I sure as hell would have nothing to do with it.

*****

Now that I look over these examples, nitroglycerin 6.4mg (25 capsule bottle) $135.00 I see more abuse than I do actual fraud.

Either way, nitroglycerin 6.4mg (25 capsule bottle) $135.00 it is a ton of waste.

How do we stop it?

They don’t let us stop it on site. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 We cannot turn away non-emergencies. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 Medics cannot refuse to transport.

Look at fraud, nitroglycerin 6.4mg (25 capsule bottle) $135.00 yes, nitroglycerin 6.4mg (25 capsule bottle) $135.00 but do something about the abuse of the health care system, nitroglycerin 6.4mg (25 capsule bottle) $135.00 too.

Nitroglycerin 6.4mg (25 capsule bottle) $135.00

There is no penalty for abusing the system.

In fact, nitroglycerin 6.4mg (25 capsule bottle) $135.00 I don’t think people even recognize that they are, nitroglycerin 6.4mg (25 capsule bottle) $135.00 in fact, nitroglycerin 6.4mg (25 capsule bottle) $135.00 abusing the system.

I think they see it as their right to use it as they see fit, nitroglycerin 6.4mg (25 capsule bottle) $135.00 no matter what the cost. Nitroglycerin 6.4mg (25 capsule bottle) $135.00 It’s there to use to their convenience.

And it doesn’t matter if it’s Medicaid, nitroglycerin 6.4mg (25 capsule bottle) $135.00 Medicare or private insurance!

Until people stop seeing their healthcare as being provided for free, nitroglycerin 6.4mg (25 capsule bottle) $135.00 there is no incentive to use it efficiently.

When you don’t have to pay the Piper, nitroglycerin 6.4mg (25 capsule bottle) $135.00 you don’t care what tune he plays.

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August 28, 2016, 5:07 pm

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Committee On The Robert Wood Johnson Foundation Initiative On The Future Of Nursing, crestor 20mg pills $251.00 At The Institute Of Medicine (2011). Crestor 20mg pills $251.00 Transforming Education. Crestor 20mg pills $251.00 In The future of nursing: Leading change, crestor 20mg pills $251.00 advancing health. Crestor 20mg pills $251.00 (pp. Crestor 20mg pills $251.00 163-220). Crestor 20mg pills $251.00 Washington, crestor 20mg pills $251.00 DC: The National Academies Press.

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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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