If you’re on Medicare or Medicaid (or have family members who are), you need to be aware of the potential for the system to be abused at your expense. Don’t be the next victim.
Medicare and Medicaid fraud costs taxpayers billions of dollars every year. Despite occasional outrage expressed by politicians, there is no sign of the problem abating. The most outrageous instances of fraud occur when medical professionals bilk the system by performing unnecessary procedures that can put patients’ health at risk.
A recent study published by Health Affairs showed how hospital patients with extended stays are discharged to boost Medicare payments. Large Medicare lump-sum payments for long-term stays kick in on day 20. The study found that patients were five times likelier to be released on day 20 than the previous three days. That’s no coincidence.
This is Way Worse Than Just Being a Number – See Below
Medicare’s “short-stay outlier payment policy created a strong financial incentive for long-term care hospitals to time patient discharges to maximize Medicare reimbursement,” according to Health Affairs.
That’s right, the same hospital you trust to nurse you back to health may extend your stay to maximize its pay. Staying an extra day or two or three or more in a hospital after you’re healthy enough to be discharged isn’t just wasteful. It isn’t just an inconvenience. It can also put you at greater risk of a deadly hospitalacquired infection.
You need to be your own medical advocate. Be insistent about wanting to be released as soon as you are medically ready. Don’t be afraid to question doctor’s orders. Your intuition is usually right. Of course, while you are in a hospital bed, you may not possess the physical or mental strength to be engaged in negotiations or worry about hospital charges.
Durable Power of Attorney for Health Care – Get It Before You Need It
That’s why it helps to have a medical advocate by your side – whether it’s a family member, an attorney, or someone you appoint to have power of attorney. If you ever become too sick to make medical decisions for yourself, you may need someone to make them for you. Unless you legally assign someone to act on your behalf, your fate could be solely in the hands of the hospital, the insurance company, and/or the government. With a document called Durable Power of Attorney for Health Care, you can enable a family member or trusted friend who has your best interests at heart to be actively involved in the decisions concerning your treatment.
The person you designate will be able to access your medical files, discuss treatment procedures with medical staff, and make decisions on your behalf. This person can help ensure that you aren’t harmed financially by erroneous or unnecessary hospital bills. He or she can also keep a close eye on your assets and finances to help ensure you aren’ t taken advantage of by anyone with malicious intent.
Check with a local attorney to see how Durable Power of Attorney for Health Care filings are handled in your state. Generally, they are simple to draw up and shouldn’t cost you much in legal fees.
Think Twice about Sending Kids or Grandkids to Medicaid Dentists
Horror stories have recently surfaced involving dentists who perform unnecessary tooth extractions, unnecessary crowns, and even unnecessary oral surgeries – all to “extract” more cash from Medicaid. Helpless children are often the preferred victims of these predatory government-subsidized dentists.
“Some dentists are clearly performing unwanted and unneeded medical procedures on children without the consent of parents and bilking Medicaid for the privilege,” wrote Senator Charles Grassley (R-IA) in a June 30th memo to the Office of Inspector General.
Never make an appointment with an unknown dentist without doing some research on his reputation. Word-ofmouth recommendations can be helpful, as can Internet searches for patient reviews. You can then check up on a prospective dentist’s professional background through your state’s dental licensing agency to make sure he is in good standing.
Generic Drugs Reconsidered – JUST OUT!
The January Independent Living contained a story (“Generic vs. Name Brand Drugs”) that highlighted the cost advantages of generic over-the-counter drugs.Same active ingredients; lower price. When it comes to headache remedies, that may be all you need to know.
But you should think twice about taking generic versions of more specialized prescription drugs. Generics may well contain the same active ingredients, but that doesn’t mean they are chemically identical to the name-brand versions they purport to replicate.
Generic drugs may contain different inactive ingredients than the brandname equivalents. Those inactive ingredients may become the cause of unexpected side effects.
Can a Time-Release Formula Kill You?
Many drugs work on a time-release formula. That means the drug releases into your system gradually throughout the day. The patents on time-release formulas used by pharmaceutical companies never run out. So when a generic drug manufacturer makes a similar drug, they have to come up with their own time-release formula.
They don’t even have to do clinical trials to see how it works. They only have to show that the active ingredient is bioequivalent to a mainstream drug to get a pass from the FDA. But if the time release is different, the effects of the drug could be different.
In one case, a woman taking the antidepressant drug Wellbutrin ended up on a generic version without realizing it. While on Wellbutrin, she felt great. But when her prescription was changed to a generic, she gained weight, suffered from fatigue, and struggled with insomnia.
Because her pharmacist hadn’t informed her about the switch, she didn’t realize it was the generic drug causing the problems.
Prevent Your Pharmacy from Pulling a Potentially Dangerous Prescription Switcheroo
In many states, your pharmacist can switch your prescription to a generic without telling you. In a case where you have multiple generic options for a single drug, you may be getting a completely different formula from one refill to the next. Don’t accept a generic version of a drug just because a pharmacist opted for it or your health insurance provider wants to save money. Ask your doctor about any potential downsides to a generic version of a drug he has prescribed.
Your doctor can add a “no substitutions” order to your prescription. This will protect you from unexpected changes at the pharmacy.