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We hear so much about health care fraud and how much it costs us all in terms of higher Medicaid, lisinopril 5mg pills $150.00 Medicare and private insurance costs, lisinopril 5mg pills $150.00 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, lisinopril 5mg pills $150.00 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, lisinopril 5mg pills $150.00 I’m wondering, lisinopril 5mg pills $150.00 what is actually considered fraud?

Let me give some examples, lisinopril 5mg pills $150.00 and help me understand whether or not this is fraudulent behavior. Lisinopril 5mg pills $150.00 The examples are purely hypothetical and do not represent any known individuals, lisinopril 5mg pills $150.00 living or dead, lisinopril 5mg pills $150.00 or specific situations in any known emergency department, lisinopril 5mg pills $150.00 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, lisinopril 5mg pills $150.00 not insulin).

Lisinopril 5mg pills $150.00 Fraud? If the patient does not claim an emergency problem, lisinopril 5mg pills $150.00 there is no deception, lisinopril 5mg pills $150.00 ergo no fraud. Lisinopril 5mg pills $150.00 But if the Medics can’t triage this call out (aka, lisinopril 5mg pills $150.00 say “HELL, lisinopril 5mg pills $150.00 no!”), lisinopril 5mg pills $150.00 there is a $1000 ambulance bill and it’s at least $1000 to walk in the ER. Lisinopril 5mg pills $150.00 The patient pays nothing. Lisinopril 5mg pills $150.00 If this isn’t a fraudulent use of the EMS system, lisinopril 5mg pills $150.00 what do we call it, lisinopril 5mg pills $150.00 abuse? Abuse for personal gain?

  • A parent walks in to the emergency department with his eight children, lisinopril 5mg pills $150.00 all of whom are covered by Medicaid. Lisinopril 5mg pills $150.00 He wants all eight children seen for colds. Lisinopril 5mg pills $150.00 It is the middle of the day. Lisinopril 5mg pills $150.00 The local pediatric clinic is open. Lisinopril 5mg pills $150.00 It is ascertained that the clinic will see all the children later in the day. Lisinopril 5mg pills $150.00 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. Lisinopril 5mg pills $150.00 The response is “I don’t care. Lisinopril 5mg pills $150.00 I’m not paying for it.”

Lisinopril 5mg pills $150.00 Fraud? Again, lisinopril 5mg pills $150.00 no claim of an emergent problem, lisinopril 5mg pills $150.00 so no fraud by definition. Lisinopril 5mg pills $150.00 But the ED cannot, lisinopril 5mg pills $150.00 by law, lisinopril 5mg pills $150.00 turn the father and the children away, lisinopril 5mg pills $150.00 at least here in CA. Lisinopril 5mg pills $150.00 So, lisinopril 5mg pills $150.00 if the cost of a clinic visit is $20 (for example) and the total visit for each child in the ED is $2000, lisinopril 5mg pills $150.00 that’s quite a bill that Medicaid now has to deal with. Lisinopril 5mg pills $150.00 Again, lisinopril 5mg pills $150.00 if it’s not fraud, lisinopril 5mg pills $150.00 do we call it abuse for personal gain?

  • A patient covered by Medicaid utilizes the EMS system for transport, lisinopril 5mg pills $150.00 requesting a hospital quite a distance from where they live. Lisinopril 5mg pills $150.00 The chief complaint given the paramedics is not the same complaint they state on arrival. Lisinopril 5mg pills $150.00 The revised complaint would have required the medics to take them to the closest hospital. Lisinopril 5mg pills $150.00 This is the fifteenth visit in four weeks. Lisinopril 5mg pills $150.00 All by ambulance. Lisinopril 5mg pills $150.00 Given the patient’s history and the chief complaint on arrival, lisinopril 5mg pills $150.00 most ED docs feel obligated to at least a minimal work-up. Lisinopril 5mg pills $150.00 Multiple doses of narcotics are required. Lisinopril 5mg pills $150.00 Lots of narcotics. Lisinopril 5mg pills $150.00 Gallons of narcotics. Lisinopril 5mg pills $150.00 Hour are spent. Lisinopril 5mg pills $150.00 Disposition is always discharge.

Lisinopril 5mg pills $150.00 Fraud? I’m calling yes on this one. Lisinopril 5mg pills $150.00 Patient wants a specific facility, lisinopril 5mg pills $150.00 knows how to get there by not using an emergent symptom until arrival – that is deception, lisinopril 5mg pills $150.00 at least. Lisinopril 5mg pills $150.00 It’s drug seeking, lisinopril 5mg pills $150.00 and drug seeking is fraud, lisinopril 5mg pills $150.00 hands down. Lisinopril 5mg pills $150.00 But how do you prove it? In this example, lisinopril 5mg pills $150.00 the patient is racking up tens of thousands of dollars in medical bills on a weekly basis. Lisinopril 5mg pills $150.00 The medics can’t refuse to transport the patient, lisinopril 5mg pills $150.00 the facility can’t refuse to see the patient (although slowing down on the narcotics might slow down on the visits, lisinopril 5mg pills $150.00 no?) It’s deception for personal gain – so a fraud vote for me.

  • Patient needs a procedure. Lisinopril 5mg pills $150.00 It is not emergent. Lisinopril 5mg pills $150.00 Patient is not dying. Lisinopril 5mg pills $150.00 Patient is perfectly fine and stable pre-op. Lisinopril 5mg pills $150.00 Procedure is actually scheduled. Lisinopril 5mg pills $150.00 But in order for the private insurance company to cover the procedure, lisinopril 5mg pills $150.00 the patient must be admitted through the emergency department, lisinopril 5mg pills $150.00 and actually go to the procedure from the ED. Lisinopril 5mg pills $150.00 So, lisinopril 5mg pills $150.00 a full triage is done. Lisinopril 5mg pills $150.00 An IV is inserted. Lisinopril 5mg pills $150.00 An ED charge goes on the books.

Lisinopril 5mg pills $150.00 Fraud? Oh hell, lisinopril 5mg pills $150.00 yes. Lisinopril 5mg pills $150.00 Would someone explain to me why this is not fraud? If you need a procedure, lisinopril 5mg pills $150.00 you go the normal route like everyone else. Lisinopril 5mg pills $150.00 This pretending you had to come into the ED first is a bunch of bull***. Lisinopril 5mg pills $150.00 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, lisinopril 5mg pills $150.00 I see more abuse than I do actual fraud.

Either way, lisinopril 5mg pills $150.00 it is a ton of waste.

How do we stop it?

They don’t let us stop it on site. Lisinopril 5mg pills $150.00 We cannot turn away non-emergencies. Lisinopril 5mg pills $150.00 Medics cannot refuse to transport.

Look at fraud, lisinopril 5mg pills $150.00 yes, lisinopril 5mg pills $150.00 but do something about the abuse of the health care system, lisinopril 5mg pills $150.00 too.

Lisinopril 5mg pills $150.00

There is no penalty for abusing the system.

In fact, lisinopril 5mg pills $150.00 I don’t think people even recognize that they are, lisinopril 5mg pills $150.00 in fact, lisinopril 5mg pills $150.00 abusing the system.

I think they see it as their right to use it as they see fit, lisinopril 5mg pills $150.00 no matter what the cost. Lisinopril 5mg pills $150.00 It’s there to use to their convenience.

And it doesn’t matter if it’s Medicaid, lisinopril 5mg pills $150.00 Medicare or private insurance!

Until people stop seeing their healthcare as being provided for free, lisinopril 5mg pills $150.00 there is no incentive to use it efficiently.

When you don’t have to pay the Piper, lisinopril 5mg pills $150.00 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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