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We hear so much about health care fraud and how much it costs us all in terms of higher Medicaid, cheap canadian viagra Medicare and private insurance costs, cheap canadian viagra 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, cheap canadian viagra 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, cheap canadian viagra I’m wondering, cheap canadian viagra what is actually considered fraud?

Let me give some examples, cheap canadian viagra and help me understand whether or not this is fraudulent behavior. Cheap canadian viagra The examples are purely hypothetical and do not represent any known individuals, cheap canadian viagra living or dead, cheap canadian viagra or specific situations in any known emergency department, cheap canadian viagra 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, cheap canadian viagra not insulin).

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

  • A parent walks in to the emergency department with his eight children, cheap canadian viagra all of whom are covered by Medicaid. Cheap canadian viagra He wants all eight children seen for colds. Cheap canadian viagra It is the middle of the day. Cheap canadian viagra The local pediatric clinic is open. Cheap canadian viagra It is ascertained that the clinic will see all the children later in the day. Cheap canadian viagra 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. Cheap canadian viagra The response is “I don’t care. Cheap canadian viagra I’m not paying for it.”

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

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

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

  • Patient needs a procedure. Cheap canadian viagra It is not emergent. Cheap canadian viagra Patient is not dying. Cheap canadian viagra Patient is perfectly fine and stable pre-op. Cheap canadian viagra Procedure is actually scheduled. Cheap canadian viagra But in order for the private insurance company to cover the procedure, cheap canadian viagra the patient must be admitted through the emergency department, cheap canadian viagra and actually go to the procedure from the ED. Cheap canadian viagra So, cheap canadian viagra a full triage is done. Cheap canadian viagra An IV is inserted. Cheap canadian viagra An ED charge goes on the books.

Cheap canadian viagra Fraud? Oh hell, cheap canadian viagra yes. Cheap canadian viagra Would someone explain to me why this is not fraud? If you need a procedure, cheap canadian viagra you go the normal route like everyone else. Cheap canadian viagra This pretending you had to come into the ED first is a bunch of bull***. Cheap canadian viagra 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, cheap canadian viagra I see more abuse than I do actual fraud.

Either way, cheap canadian viagra it is a ton of waste.

How do we stop it?

They don’t let us stop it on site. Cheap canadian viagra We cannot turn away non-emergencies. Cheap canadian viagra Medics cannot refuse to transport.

Look at fraud, cheap canadian viagra yes, cheap canadian viagra but do something about the abuse of the health care system, cheap canadian viagra too.

Cheap canadian viagra

There is no penalty for abusing the system.

In fact, cheap canadian viagra I don’t think people even recognize that they are, cheap canadian viagra in fact, cheap canadian viagra abusing the system.

I think they see it as their right to use it as they see fit, cheap canadian viagra no matter what the cost. Cheap canadian viagra It’s there to use to their convenience.

And it doesn’t matter if it’s Medicaid, cheap canadian viagra Medicare or private insurance!

Until people stop seeing their healthcare as being provided for free, cheap canadian viagra there is no incentive to use it efficiently.

When you don’t have to pay the Piper, cheap canadian viagra you don’t care what tune he plays.

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  • NPs Save Lives
    NPs Save Lives

    March 22, 2011 at 4:36 pm

    In Florida, I think the ER has the right to refuse to treat a patient once it is established that it is not an emergency and are told to see their provider. I am available 24/7 on call and we have nurses who triage for me to keep patients from going to the ER unnecessarily. Does it work? Most times not, because the pt goes to the ER without calling the after hours. They claim that they didn’t know…yeah right…

  • Julie

    March 24, 2011 at 9:41 am

    This is a massive problem and is the reason why General Pratitioners in the UK increasingly ‘front end’ ER departments here. The patient is triaged and then if it is something that should have been seen in a primary care type place they are seen, treated and sent away. No amount of education seems to help since you don’t need to plan, make an appointment or wait longer than the queue in the ER. Maybe you can come up with a solution and make that first million?

  • locums

    March 26, 2011 at 1:27 am

    Hmmmx NIce

  • […] Kim at Emergiblog helps explain fraud and abuse in the medical setting. […]

  • The EMT Spot » The March EMS Roundup
    The EMT Spot » The March EMS Roundup

    April 3, 2011 at 8:06 am

    […] appropriate trauma facility. Emergiblog asked us to consider whether some patient presentations are fraud or abuse? Everyday EMS Tips pondered the use of a defibrillator on a patient with an impaled metal object. […]

  • Efoghor Joseph Ezie
    Efoghor Joseph Ezie

    April 7, 2011 at 1:39 am

    That is just the nature of man. Everyone wants to manipulate the next person to his own advantage. People to want to get things and avoid paying the price.People want to be regarded for what they are not.
    The best thing everyone must learn is how to be sincere to your fellow men even if it would cost you something.
    People should be able to trust whatever you tell them because they know you to be an honest person.

  • nurseygurl

    April 25, 2011 at 10:33 am

    What happened to the QMP Fad?

    At times, qualified medical persons may medically screen non-emergent cases. If a qualified medical person determines that a patient?s medical condition is non-emergent and non-urgent upon completion of the medical screening exam, the following options will be represented to the patient:
    Stay to see the Emergency Department physician for care and treatment after being registered and paying the hospital and physician fees, for such medical care and treatment.
    Follow-up with a family physician.
    Seek medical care and treatment at a community clinic. A list of community resources will be attached for reference by the patient.

  • Eric

    November 28, 2012 at 8:32 pm

    “…. the cost of seeing the eight children will be one hundred times higher in the emergency department than in the clinic.”

    “, there is a $1000 ambulance bill and it?s at least $1000 to walk in the ER. ”

    Right there is the REAL fraud and abuse. Those charges are insane. The entire medical industry needs to be revamped.

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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