Medicaid. Is it being abused? - page 11

Medicaid was a great idea when first introduced to assure that even the very poor could get quality health care. I just wonder when I see someone drive up in a newer car come up to the triage desk... Read More

  1. by   flashpoint
    Several of us brought up our concerns to our manager and were told to stay out of it. She agreed that there was abuse / misuse, but felt that it was not our place to report it...she did turn over several charts to risk management, but we never knew where they went from there...
  2. by   grannynurse FNP student
    Quote from cotjockey
    Several of us brought up our concerns to our manager and were told to stay out of it. She agreed that there was abuse / misuse, but felt that it was not our place to report it...she did turn over several charts to risk management, but we never knew where they went from there...

    Sorry but your manager needs to update her information. And it should be reported not only to risk management but to the responsible state agency. And the reporting can be done by anyone. I had the experience of questioning a hospital bill, being told they would straight it out and then having them submit the uncorrected bill, twice. Guess it was a little clerical error.

    Grannynurse
  3. by   grannynurse FNP student
    Quote from mercyteapot
    I don't think her response was to your post, but to the various posts that keep alleging fraud because some people on Medicaid seem to live beyond their means ("seem" being the operative word, because, really, who knows). I also think it is interesting that the question is about "abuse" and the conversation keeps turning to "fraud". Some of us are talking about basic misuse, meaning visiting the ER when a PCP visit (or good old common sense) is appropriate. Others are alleging deception and malfeasance. I would say that yes, this system, like all others, is sometimes abused. And I'm sure there is some fraud, too. You hear a lot more about it on the part of providers and patients, or MC workers and patients, or MC workers and providers, who are in collusion, though. It makes no sense that any great percentage of people who manage to pass the eligibility test are actually living in the circumstances that have been alleged on this board.
    I am sure that there are some who feel that some of my ER visits are misuse of my Medicare coverage. I stayed away from Managed Care Medicare because I would have had to speak with someone and get approval before seeking out treatment. Ever wonder why people use the ER as their primary source of care? Most because they can't find a physician or when they call are told they can have an appointment in a week or because one or both parents work, or the person just gets worse. I may have problems breathing during the day but resist going in because my rescue inhaler works for a while. And generally my breathing difficult gets worse in the evening or night. Generally I get yelled at for driving myself in and not coming in sooner. Can't win for losing.

    I never had a problem in dealing with a patient who came into the ER for treatment of whatever their problem was. It wasn't my place to sit in judgement of why a patient came into my ER, it was my place to treat them. I am just so tired of hearing about all this alleged abuse, misuse and/or fraud on the part of people who receive second rate care and wait hours, in an ER.
    Enough said.

    Grannynurse
  4. by   grannynurse FNP student
    Quote from liljulz0613
    No I wasn't posting in response to yours. I ment to reply to a post that was on the first page of the forum. lol. Sorry if it caused any confusion. SWFlorida has made a post that was on the first page and it just hit a nerve. Sorry if my post seems a bit harsh.
    No problem. I also live and have worked in SW Florida. I understand why you were upset. For a young person, you show remarkable insight:wink2: I just wonder how some can have the time. I understand, from one poster, she works in an extremely small hospital and wears several hats. I worked in a 150 bed hospital, back in 1980 but we always had a clerk, on all three shifts, in th ER. And as I have already posted, it is not my place to judge why someone uses the ER as their PCP but to treat them. And if their is time, educate them.

    Grannynurse
  5. by   Rosa2Little
    Quote from purplemania
    There are people with large incomes who cheat on their taxes too, so income is not the indicator for stealing.


    well said!
  6. by   MicheleNursStudent
    .
    Last edit by MicheleNursStudent on Mar 18, '06
  7. by   mercyteapot
    Quote from grannynurse FNP student
    I am sure that there are some who feel that some of my ER visits are misuse of my Medicare coverage. I stayed away from Managed Care Medicare because I would have had to speak with someone and get approval before seeking out treatment. Ever wonder why people use the ER as their primary source of care? Most because they can't find a physician or when they call are told they can have an appointment in a week or because one or both parents work, or the person just gets worse. I may have problems breathing during the day but resist going in because my rescue inhaler works for a while. And generally my breathing difficult gets worse in the evening or night. Generally I get yelled at for driving myself in and not coming in sooner. Can't win for losing.

    I never had a problem in dealing with a patient who came into the ER for treatment of whatever their problem was. It wasn't my place to sit in judgement of why a patient came into my ER, it was my place to treat them. I am just so tired of hearing about all this alleged abuse, misuse and/or fraud on the part of people who receive second rate care and wait hours, in an ER.
    Enough said.

    Grannynurse
    And that goes back to the fact that it isn't so much abuse of Medicaid, it is a system that encourages, and in some cases, necessitates, the very things that end up being problems.
  8. by   ednurse17
    I think Medicaid/Medicare is wonderful for the people who really need it. I too get tired of how patients abuse the system. The ones that come in at 0200 in the morning, wanting a pregnancy test, that's it, nothing else. I tell them they can buy a pregnancy test at the dollar store or go to the health dept for free, they say... it's okay, I'm on medicaid. Just makes you want to blow your top!!! I had a patient the other night who came in with an asthma attack, we gave her a couple of nebs and when I was handing her her D/C papers and scripts, she asked me for an inhaler. Told me she couldn't afford the $1.00 it took to buy it. I asked her if she smoked... her reply was yes. Well, if you can afford a pack of cigs, you can afford your inhaler, bye-bye.....
  9. by   grannynurse FNP student
    Quote from ednurse17
    I think Medicaid/Medicare is wonderful for the people who really need it. I too get tired of how patients abuse the system. The ones that come in at 0200 in the morning, wanting a pregnancy test, that's it, nothing else. I tell them they can buy a pregnancy test at the dollar store or go to the health dept for free, they say... it's okay, I'm on medicaid. Just makes you want to blow your top!!! I had a patient the other night who came in with an asthma attack, we gave her a couple of nebs and when I was handing her her D/C papers and scripts, she asked me for an inhaler. Told me she couldn't afford the $1.00 it took to buy it. I asked her if she smoked... her reply was yes. Well, if you can afford a pack of cigs, you can afford your inhaler, bye-bye.....
    Sorry but it is not the place of staff to question why a patient comes to the ER, even for a pregnancy test at two in the morning. And I really have to question a person coming into an ER for a pregnancy test but I would be happy she did and take time to educate her. As for the asthmatic comment. Depending on where one lives, there are places where there are no twenty four hour pharmacies. Second, once again it is not the nurse's place to question how a patient spends their money. Sorry, it isn't even the taxpayers place to question how assistance is spent. The patient suffers from asthma and required treatment. Failure to provide the inhaler just sets the patient up for a return visit. And more complaints about irresponsible Medicaid recipients, wasting everyones tax dollars.

    Grannynurse
  10. by   soliant12
    Quote from grannynurse FNP student
    Sorry but it is not the place of staff to question why a patient comes to the ER, even for a pregnancy test at two in the morning. And I really have to question a person coming into an ER for a pregnancy test but I would be happy she did and take time to educate her. As for the asthmatic comment. Depending on where one lives, there are places where there are no twenty four hour pharmacies. Second, once again it is not the nurse's place to question how a patient spends their money. Sorry, it isn't even the taxpayers place to question how assistance is spent. The patient suffers from asthma and required treatment. Failure to provide the inhaler just sets the patient up for a return visit. And more complaints about irresponsible Medicaid recipients, wasting everyones tax dollars.

    Grannynurse


    Sorry, But it is the nurses and societies (taxpayers) responsibility to question and educate people on the fact that they should utilize a primary care practitioner for theit health care and not the ER. Kudos to the RN for telling this patient to cut back on the smoking and buy his/her inhaler instead. Perhaps if they quit smoking they wouldn't need to visit the ER for an inhaler period. Using your logic a bartender should not question a drunk who keeps ordering shots of whiskey.
  11. by   ednurse17
    fortunately, our town is blessed with a 24 hr pharmacy, it was the doctor's decision, not mine, that the patient not receive the inhaler. As far as the pregnancy test is concerned, well, that's a whole other matter. We do ask questions as to why they present to the ER. If they want a pregnancy test, we ask them if they are having any problems. Bleeding, nausea, etc.... Just wanting to know if they are pregnant or not? We do tell them the resources they have.. the pregnancy center, the health department, the clinic, the list is endless. But followup is always a problem. They never do.
  12. by   grannynurse FNP student
    Quote from soliant12
    Sorry, But it is the nurses and societies (taxpayers) responsibility to question and educate people on the fact that they should utilize a primary care practitioner for theit health care and not the ER. Kudos to the RN for telling this patient to cut back on the smoking and buy his/her inhaler instead. Perhaps if they quit smoking they wouldn't need to visit the ER for an inhaler period. Using your logic a bartender should not question a drunk who keeps ordering shots of whiskey.
    Whatever or not a patient smokes and suffers from asthma is really no one's business except the treating physician. I am an asthmatic. I do not smoke and never have. My daughter and SIL both smoke. They go outside to smoke so as not to impact second hand smoke on myself or my grandchildren. And you know something, I am sick and tired of anyone asking me if I smoke when I come into the ER. And I am equally tired of some of the judgmental attitudes that I have had the misfortune to read, regarding the wasting of their tax money. I don't like some of the things that my state and federal government waste tax dollars on. I certainly do not impart my distaste on the recipients of such latest. And just perhaps some should up date their education on the causes of asthma and its treatment. The comment regarding drinking, it is worth ---------------------------------

    Grannynurse
  13. by   grannynurse FNP student
    Quote from ednurse17
    fortunately, our town is blessed with a 24 hr pharmacy, it was the doctor's decision, not mine, that the patient not receive the inhaler. As far as the pregnancy test is concerned, well, that's a whole other matter. We do ask questions as to why they present to the ER. If they want a pregnancy test, we ask them if they are having any problems. Bleeding, nausea, etc.... Just wanting to know if they are pregnant or not? We do tell them the resources they have.. the pregnancy center, the health department, the clinic, the list is endless. But followup is always a problem. They never do.
    Your town is lucky. And you could have made the information regarding it being the doctor's decision, in your initial post but for some reason you chose not to. My town also has an 24 hour pharmacy. And they charge the most for any medications. I always tell the physician I can't get it filled until regular business hours (at my regular pharmacy) and is it all right. I have lived in towns that don't, believe it or not. And as I said, I worked in several ERs and never had a patient present demanding a pregnancy test. Guess I have just be extremely lucky. But then again, I haven't worked in 15 years and perhaps the public has changed since then. But then I would wonder why someone was coming in at such an hour and do something a little more then provide them with a list.

    Grannynurse

close