Wednesday, September 26, 2012

fraud is fruad is fraud

If you come into the ER with a stubbed toe, you could go out with ten diagnosis' on your visit record.  If you are admitted there will probably be twenty.  Everything that has ever been wrong with you will be noted as part of your discharge or admission diagnosis. Depending on which doctor you get, it will be more or less.

Knowing this, when I saw an article in the New York Times a couple of days ago (September 24: "Medicare Warning to Hospitals on Medicare Abuse"),  I was fascinated.  It talks about how the government isn't going to tolerate hospitals that try to "game the system".  In a statement, government officials were quoted in the following:

 “There are also reports that some hospitals may be using electronic health records to facilitate ‘upcoding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care".

The article also states:  

"Much of the higher billing is taking place in hospital emergency rooms, where hospitals are classifying many more patients as sicker and needing more care". 

Oh my goodness, ya think?????!!!  ER nurses have been talking about this for YEARS.  The fact that people are being way overtreated. There are very few people who come into the ER who don't have an IV started, aren't given IV medications, lab tests, xrays, etc.  It has gotten to the point of ridiculousness.  If you have a virus or a tummy ache you get all of this shit.

Doing all of this allows doctors to up the level of care and CHARGE MORE MONEY, and therefore MAKE MORE MONEY.  It is nothing less than fraud.  Now doctors try to justify all of this by whining about "liability", "patient satisfaction",  etc.  Bullshit. This is called greed folks.

It is done for all patients, not only medicare patients - espescially patients with insurance. Your chance of getting an MRI or a CT ANGIO increase in direct proportion to what kind of insurance you have.

Lets hope the government truly cracks down on this shameful practice of medicine.





Ally said...

I disagree that ER docs are doing big workups to make more money. A huge percentage of the patients in the ER don't have insurance and have no intention of paying their bill; there is no monetary benefit to anyone for doing a big workup on them. If you said that patients with private insurance have been shown to receive bigger ER workups, that'd be different.

Doctors do big workups because they don't want to get their asses sued off by some lawyer who can find some expert witness to testify that they should've ordered this, that or the other thing to rule out X, Y or Z.

Ally said...

P.S. Check out this more fair-minded article about what could be going on with upcoding: