My World and Welcome to It!

These are my thoughts and opinions about life in general. I also get daily prompts from DSP which inspire me to write. If I throw in some scrapbook pages I've done, photos I've taken, and stories about me, you will have an idea about my loony life!

Monday, November 19, 2007

Medicare Fraud or Taking Advantage of the Elderly?

Is it Medicare fraud or are they just taking advantage of the elderly? Let me tell you an interesting story and let you decide...

Recently my 87 year old dad suffered a mild stroke and after 2 days in the hospital he was sent to ManorCare rehab center in Boynton Beach, FL for 6 days (the limit that their insurance would pay). The day he got there someone came in and had him sign papers telling him about his copay responsibility. After that we asked that he not be given papers to sign without his wife being present and thought they respected our request. We realized how important it was to have a family member there because on the 5th day he was there he was asked to sign blank papers (the girl told him that she would fill all the blanks in for him when he asked for today’s date). He was even asked if he wanted to sign over all his finances into a trust fund run by the center but he refused. We asked for a copy of the completed forms and he has never received a copy of them.

On the day before his discharge, my dad was asked if he had a company in mind to come in to do some home health care and he didn’t. He didn’t even know what home health care was and what services are provided. This nurse just happened to have a friend who works for a company so she recommended her friend. The friend comes in and tells my parents that their insurance won’t pay for her services and proceeds to tell them what services my father will need and what their insurance will and won’t cover. When we asked her if the doctor is ordering these services, she said she had no idea. We asked her if she talked to my parent’s insurance company and she said no. This person, at the invitation of the rehab center, was telling my parents stuff that she had no knowledge about. Now, my parents who are in their 80s, were very confused and upset, especially when this person told them they should cancel their medical insurance and go straight Medicare! She also told them a man would call them to try to get him veteran’s benefits (she said no one knows about this law, even the VA, except this man) but they would have to sign a paper promising to sign over all checks they receive from the VA to this man! Needless to say, I told my parents this was a bad idea!

Next we are told that my dad would get a walker, a port-a-potty, and a wheelchair to be brought to his room when he would be discharged. No one could tell us if the insurance covers this equipment in full or not and they resented me asking these questions. He was not even given a quad cane, which would have been the most practical thing for him to use. We never saw a doctor’s order that said my father needed these things or when he was supposed to use them. Plus, he was never trained on how to use these things or told when he was to use them. Of course they inform my parents that he needs to buy “gliders” for the walker that costs about $30 not even knowing if he needs the walker. My parents were told the potty could be used as a seat when he takes a shower but no one even knows if it fits in their tub (it doesn’t) so they have to buy a seat for the tub. There isn’t even room to set the port-a-potty in the house other than the middle of their living room. No one came out to the house to see if the wheelchair is appropriate for the house (it isn’t because there is no room to wheel it around their tiny house). Since my stepmom can’t get it in and out of the car, the wheelchair is now in the trunk of their car (where they loaded it at the rehab center) and probably won’t even be used. The potty is out in their shed now.

At 9pm the night before his discharge, he is awakened by this strange man who is delivering this equipment. The man tells him he has to sign these papers and my father, a stroke patient who is obviously confused, half asleep, and upset, signs these papers (without any family member with him). He calls his wife and is extremely upset, which I don’t blame him so I call the nurse’s station. Nobody even knew this man had gone to my dad’s room to deliver equipment (but someone had to give him a code to let him in and a code to get out of the building). We had no idea that the wheelchair was rented for his use and we had no idea what this would cost them.

The next day I see the forms he signed that say he received training on how to use all this equipment and told about infectious diseases etc. My father says the man just delivered the stuff, had him sign this paper, and he left without giving him any training! When my father is being discharged, I ask for someone to tell him how to use the stuff, plus get the wheelchair in and out of the car (we live 700 miles away so we can’t help them with this when we go home!). I am told by the therapist that he is not entitled to physical therapy on the day he is discharged but she showed my stepmom how to take the foot rests off the chair and how to fold the chair. I asked why no one showed my dad how to use the walker but she had no answer other than to tell me he was trained when they delivered the stuff (at 9pm when my dad was half asleep?). When I asked why he needed a portapotty since he didn’t need one in the hospital or the rehab center, I was told that everyone gets one when they leave. Is this a door prize for choosing their center? If everyone gets one and many of these people don’t need one, is it any wonder that our insurance rates keep increasing?

We are also told that home health care will come to their house and a physical therapist will come to their home. My father took his own shower at home last night, fed himself, dresses himself and does everything he needs to do without any help. The left side of his face tingles and his left hand is numb and tingles. He wobbles a little when he walks (but he did that before the stroke too). We also played card games for 2 nights in a row and he is as sharp as he was before the stroke mentally. He even helped my stepmom cook dinner last night. He cut up the vegetables in small pieces with a sharp knife. Why does he need these people to come to his house? I found out that their insurance will not pay for this physical therapist to come to their house but everyone implied that they would. This of course confused my parents completely because they don’t understand why the rehab center said these people would come to their house if he didn’t need their help. Three different people told them that my father would receive services at home. Of course my parents understood this to mean that the insurance would pay for these services totally.

I found out their insurance will pay for the home health care to come out for 7 weeks for less than 35 hours per week. Someone is getting paid to provide services that my father does not need because no one has even been to his home to see what is appropriate. The rehab bought him a port-a-potty that he doesn’t need, won’t use, and isn’t even appropriate for his home. A wheelchair was rented for him (I was told by the insurance company that it is at no cost to my dad but he can keep it as long as he has this insurance) but it is so heavy, they can’t even get it in and out of the car. They can’t even use it in their house because their house is too small. My stepmom hopes that when they go out, if it is needed, they can ask complete strangers to help them get it in and out of the car. Meanwhile, this company is getting paid! No wonder our insurance rates keep increasing!

Is this normal for the elderly to be taken advantage of this way or is it just this rehab/nursing home that does business this way? I have written a letter to the director of ManorCare asking for a list of agencies that I can file a complaint with but I haven’t received this yet. If I don’t get any information from them, I will contact the Insurance Commission. My parents are not incompetent but they are easily confused and taken advantage of by all of these people and companies that want to soak them for every penny they have. This makes me furious that this goes on and hope that I can make lawmakers and regulatory agencies aware of what is going on. I know all of this complaining can’t help my parents but if this knowledge could help other elderly people, it will be worth it. I will begin my letter writing campaign to federal, state, and any licensing agencies I can complain to and hope to change this from happening.

If you have any suggestions of people I should contact, please feel free to leave your suggestions in your comment.

6 comments:

Anonymous said...

Oh, Pat - to me it sounds like the Home itself is scamming people. Most older patients probably don't have any family around (or just don't care enough ...) so that is why they were asking for him to sign papers - also it seems they wanted until family members left him alone to sign any papers. Not that insurance isn't outrageously ridiculous on a lot of stuff, but the nursing home sounds fishy to me. I don't know who you could contact though! What about Better Business Bureau?

Unknown said...

Not living in America, I can't help you with contacts.

I just have to say that is shocking & sounds terribly fishy to me. Someone somewhere is making mega bucks of elderly people & that stinks!

Unknown said...

First off contact his insurance company and let them know what has happened. They may be in a better situation for helping out especially if it is the rehab that is scamming. If you get no relief or help from them, the Better Business Bureau and the Insurance Commission would be next in line. If you have any friends that are lawyers ask them what you can do about any charges that were incurred due to signing papers while your father was under duress and without family members present. Make sure your father sends you faxes of all invoices he receives. Check them over carefully. If there are charges which you know are incorrect or just out and out false (ie. training) make sure you advise the insurance company of it. If the rehab says the charges aren't covered by insurance do not pay what is in dispute. But make sure a letter is sent in explaining why the disputed amount isn't being paid. It is business like this that keep our insurance costs so high.

Anonymous said...

Unfortunately, fraud does happen. You definitely should report this incident to a regulatory body. You could call Medicare and report the situation.

To assist you in understanding Medicare, you can check out: http://www.medicare.gov/ You can compare nursing homes and home health agencies. You can compare hospitals. You can learn what Medicare covers.

The Office of Inpsector General takes all fraud complaints seriously. You can reach this office at: http://www.medicare.gov/FraudAbuse/HowToReport.asp

There is also an incentive reward program for reporting Medicare fraud. I'm not sure if it is still in effect, but you can check out: http://www.medicare.gov/Publications/Pubs/pdf/rmf.pdf

If you believe that this type of occurrence is common - from what you wrote, it did appear to be "normal" business, I'd even recommend contacting your attorney general's office. That office is always quite helpful too.

Not to discourage you, but it will take time before anything happens IF anything happens. The strength of your claims and the frequency it occurs will be huge factors.

Good luck!

Anonymous said...

I was reading your story today after searching google on taking advantage of the elderly.I am dreadfully sorry to hear what happened in your case and I hope those people who did that to your father were identified and stopped from doing it again.
I read another blog of a guy who had a similar problem although it was relatives this time who did the same to his mom but he eventually told the story on the web
http://petercherbi.blogspot.com/2007/02/picture-is-worth-thousand-words-images.html

Anonymous said...

i know an elderly man who i think his son and daughter in law are taking quite the advantage of him. They used his house as collateral in buying a home, and now want to charge him $1,000.00 a month rent. They also drain his bank accounts so he has barely any money to buy food and extras. The man is in a wheelchair and i fear he is being used so they can end up putting him in a home. im wondering how and where i can find out if there is a case for him or not?