What examples of Medicare fraud have you witnessed?

SDN Members don't see this ad. (About Ads)

I'm starting a new post because I believe that a lot of medicare fraud happens on a smaller level than what we hear about through the media. Unless they rob the government of over a million bucks, it isn't big news. Also, I wanted to VENT about what happened with my own family.

My family put my grandfather in a nursing home for the final days of his life, specifically the last 14 days of his life. Medicare paid 100 % for ten days and then 80 % for the last four days. The bill for a given patient at this facility was $137 per day as posted on a paper in the lobby. However, when my grandmother went to pay the 20% that she owed for the last four days, she asked how much 20% of 137 was. The lady at the desk then told her that 137 dollars WAS the 20% of the bill. Whaaaat??? My grandmother blinked twice and did some quick math. "So the actual price is almost 700 dollars a day?" The lady didn't respond, she just turned around in her chair. Therefore my grandmother paid 137 x 4 = 548 dollars! This price is much much higher than the price they quoted at the front, and it seems that they simply multiplied the price for medicare patients by five in order to artificially make it APPEAR the same as a person who was there without medicare. In reality, they must be billing the government for 137 x 5 = 645 dollars a day!

This really made me mad, and I have to ask y'all: Has anyone else seen something shady like this going on??? Does anyone here work at a nursing home who could enlighten me on this situation? Am I simply misunderstanding the billing process or is she being completely ripped off?

That actually seems like a pretty low per day price for end of life care.

Lots of shenanigans by home health outfits. Example: Telling a pt they have to have their services to continue to be on medicare.

Hospice only gets like 600/day which is barely enough to break even. It is expensive to pay doctors, nurses, and ancillary staff to provide total care for your loved one. Don't forget the cost of meds, supplies, facilities, insurance, etc.

I see everyday residents AND attendings documenting physical exam **** they didn't actually do.

Originally Posted by SuckySurgeon7

I'm starting a new post because I believe that a lot of medicare fraud happens on a smaller level than what we hear about through the media. Unless they rob the government of over a million bucks, it isn't big news. Also, I wanted to VENT about what happened with my own family.

My family put my grandfather in a nursing home for the final days of his life, specifically the last 14 days of his life. Medicare paid 100 % for ten days and then 80 % for the last four days. The bill for a given patient at this facility was $137 per day as posted on a paper in the lobby. However, when my grandmother went to pay the 20% that she owed for the last four days, she asked how much 20% of 137 was. The lady at the desk then told her that 137 dollars WAS the 20% of the bill. Whaaaat??? My grandmother blinked twice and did some quick math. "So the actual price is almost 700 dollars a day?" The lady didn't respond, she just turned around in her chair. Therefore my grandmother paid 137 x 4 = 548 dollars! This price is much much higher than the price they quoted at the front, and it seems that they simply multiplied the price for medicare patients by five in order to artificially make it APPEAR the same as a person who was there without medicare. In reality, they must be billing the government for 137 x 5 = 645 dollars a day!

This really made me mad, and I have to ask y'all: Has anyone else seen something shady like this going on??? Does anyone here work at a nursing home who could enlighten me on this situation? Am I simply misunderstanding the billing process or is she being completely ripped off?

Considering a hotel room is going to cost you about $100 (unless you go to a cheap place), and people in a nursing home get a room as well as housekeeping, personal hygiene care, medications and medication administration, and physician supervision. Presumably you chose a nursing home because your family was unable to provide the level of care necessary for your grandfather and unable to afford to pay someone to do so in your own home. Why would you think a skilled nursing facility would be a much cheaper.