Medicaid. Is it being abused?

chris_at_lucas_RN, RN · Jun 3, 2004

There are those unusual circumstances where a person has had a serious reverse of circumstances but still retains the trappings of their former lifestyle, but by and large, there probably is some fraud in there somewhere. I never know whether I have a moral obligation to rat someone out who seems to be stealing through fraud or figure someone will eventually catch up with them.

Yes, I think Medicaid, Medicare and insurance are abused, and I believe that it happens every time we set up something for the good of the people without considering the greed of the providers.

I have heard physicians say, "I'm going to put that you had such and such a symptom or the insurance will not pay, so if anybody asks...." I recently had a 20 minute office procedure that consisted of aspirating the fluid from 8 cysts and the fee to the insurance company was $3,750!

In the end, who winds up paying for the abuse is the taxpayers who must support the programs (i.e., we don't get to choose where our tax money is used) and the persons whose necessary programs are cut for lack of funding, because the funds are being sucked somewhere else.

Bottom line: I try to operate the best I can with what I have, at the time, and let it go. When I cannot do that, my first step is to do whatever it takes to get me back to trying to operate the best I can with what I have.... etc.

Thanks for the thought-provocation. Good thread.

Trauma Columnist · Jun 3, 2004

If you see or know of Medicaid abuse there is usually a hotline to call to report it.

txspadequeenRN, BSN, RN · Jun 3, 2004

I feel I need to reply to this , At one time I was married had plenty of money , no bills and was making great as a nurse. Then I got a divorce thinking that I still would be ok with even less payments (no mort,sold the house living in a apt) I bought a brand new Camero (now mind you I did have a new car it was just a family car) . After the divorce I ended up getting pregnant (now that is a whole other story) I worked for a while then I was put in the hospital with a unfortunate accident. I lost my job and insurance because I couldnt work. After , I started working for agency here and there . So I headed off to the Human Dept to apply for medicad , well first I qualified because I had lost 75% of my pay , but I did not quailify because the lady hooked her little computer up and has a direct entry into the Texas Dept of Transportation and she pulled up her screen and said " you drive a brand new 2001 camero" I said yes told her my situation no insurance not making any money. ( Even if I could get insurance at my new job Their was a pre exsisting clause present) DENIED!!!!!!! I tried to sell the camero but wouldnt you know it my 750 credit rating went straight down to 500 with in a couple of months because of bills that didnt get paid as a result of the divorce. I didnt have money to pay cash for a cheap car and needed to get to work . And trading it in on a cheaper car was out my credit now was bad and the interest they were asking for was close to 26% and currently was paying 12%. Did I mention that I had 2 other small children at home that had to eat. There is more to this story but I dont have the time or the strenght to write it . In the end I ended up at JPS hospital in Ft Worth 42 weeks pregnant B/P 200/120 and preclamptic. The moral of the story is yes I had a brand new camero , but I wouldnt have had If I had known the stiuation to come. I truly needed help , and was by no means trying to skim the system.That was 3 years ago . I was and still am one of those people who are caught in the middle make to much but not enough. I had medicad for my now 5 children but guess what that was dropped 5/31, they say I make to much . My insurance a month would be 800.00 at work , WHO CAN PAY THAT!!!!!! So I do with out . My new husband and I live off my LVN income with 5 children we are both full time students. That &(*&)*& camero is still causing my grief it is out in my front yard with a for sale sign on it. Now im not saying that there are not people who take advantage of it . But I want to Make a point that sometimes the wounds are deeper than they look. And in my situation I had no other choice ...:)

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 in designer clothes and lots of gold jewelry and they are on medicaid. I know of many who are the working middle class who are struggling to pay their own insurance premiums. Why do so many folks get a free ride? Or am I missing something here?

purplemania, BSN, RN · Jun 3, 2004

Bless your heart, Denise. Your story does point out the failure of the "system". When I was married we filed taxes jointly, and he made 3 times what I made. After our divorce I could not get student loans or financial aid because the previous tax return indicated a higher income than I actually enjoyed. I was working full time, in a low paying job, but sacrificed a lot to get into school and stay there till I had my RN license.

As for original question, yes, Medicaid is being abused. If there was a way to identify the abusers the people who REALLY need help would have more help available. There are people with large incomes who cheat on their taxes too, so income is not the indicator for stealing.

SWFlorida · Jun 3, 2004

How about the young teenage girls who end up pregnant. Its almost an automatic qualification for full medicaid insurance, housing and food stamps. This can go on for generations.

Perhaps the government should tax those who have children out of wedlock as a burden to society. This may encourage teens to practice birth control. Those who are able to care for their children could receive a tax break if they show they have proper insurance, a home, and a full time job.

Is the system geared for the achievers or the irresponsible?

Rain · Jun 4, 2004

A few weeks ago, I was discharging a patient from the ER. The MD wrote a prescription for benadryl. I gave the script to the patient and also said you can buy this over the counter if you want to. (it was 1 am in the morning-thought it would be easier just to buy it OTC than to wait for a pharmacy...) Anyway, the patient smirked and said "well it's free for me" and starting laughing. And she waas being serious! I was so mad I just walked out the door.

Long Term Care Columnist / Guide · Jun 5, 2004

I guess I never learned to work the system.......when my family was on Medicaid years ago, we were so poor that we couldn't even afford a car, let alone a late model. In fact, we have a CHILD who's younger than either of the two cars we own now, and we're well above the poverty line. Guess we were just too stupid to figure out how to get us one of those "welfare Cadillacs". :stone

angel337, MSN, RN · Jun 5, 2004

just because a person is broke does not mean they have to look it. i understand the whole idea of brand new cars and jewelry and this used to upest me to, but i realize that you never know what life experiences a person has had and it is unfair to judge them off looks and possesions alone. when i was a medical assistant( a long time ago) i had to apply for financial aid. i was an independent student, living alone, no children and no help from my parents. when i sat down with the counselor she made a comment about my coach purse and said that if i could afford an expensive purse like that, i obviously could afford the tuition. she pointed out that she did not have a coach purse and she worked full time. she also assumed i had children. i politely told that idiot that the purse was a gift form my grandparents for my birthday and that i lived alone with no dependents. well let me tell ya....she apologized after picking her face off the ground. she went on to explain about other girls in the program and how they had this and that and were applying for financial aid. she was making assumptions and generalizations for alot of reasons i don't care to discuss (it will be a whole other thread). i can't concern myself with what other people APPEAR to have. sometimes the more people have is just an indication of how much debt they have. i mean, how well can you really live off a medicaid check? a nice car and jewelry does not always equate a nice quality of life.

caroladybelle, BSN, RN · Jun 5, 2004

Where is the open can of worms smiley when you need it?

lisaloulou · Jun 5, 2004

Is Medicaid abused? YES

Can citizens who have temporarily fallen on hard times qualify for it- often not.

Can women come from anywhere in the world and give birth and have their child qualify for the best in medical care,PT,OT,medications,home health,DME, transportation to and from appointments? YES

My son who made $8000 one year and ended up with a $12,000 hospital bill could not receive one cent worth of "free" anything- monthly RX was over $250. They continue to pursue him to the ends of the earth for money even years later. The hospital has a religious foundation, but couldnt see fit to reduce the bill through charity for a 23 year old male who couldnt work at the moment because he made 8K the previous year.

Same hospital,family brings in a non resident alien family member who receives inhouse care for several weeks- they go home with bill forgiven,free meds and DME and home health visits.

I see this stuff on a daily basis. If you know the system, it is very easy.Why live in a third world nation when you can come here and live even without official documentation and enjoy what everyone else has to work for for free?

Just keep those babies coming......

Amylcd · Jun 5, 2004

As someone who use to receive medicaid, I got those looks like 'she can't be on it, look at her clothes, car, etc'. Yes, I was poor, did I need to dress or act like it? No. I made every attempt to look professional when I went out in public. Everything I had was gotten before my husband was laid off from his job. We went from getting around 4,500 a month to my little above minimum wage job which brought in about 1,300 (and this included overtime!) Rough times

Yes, the system does get abused, but you don't know their situation so it's better not to judge.