Medicare Abuse

[RunningWithScissors]

Medicare could save millions of dollars if they had a way to hotline medicare abuse. I wish I could pick up the phone and report the physicians who keep patients in the hospital sucking up resources because the patient (or family member) doesn't want to go home. (No medical necessity).

Or the frequent flyer who repeatedly gets admitted for phony ailments, gets their PCA for days on end and then gets discharged with no med changes or new diagnosis.

Or the "pulmonologist" who doesn't wean the vents for days for no reason, because he gets more $$ for an ICU visit.

I could go on, but you get the point.

Until physicians get paid one lump sum per DRG like hospitals, nothing will change.

I think hospitals should deny priveledges to physicians who suck the life out of our hospitals.

[bargainhound, RN]

cotjockey

Sounds like this patient would qualify for hospice.

Hospice would pay for patient's needs related to her diagnosis.

This is still a medicare benefit, but it would help this patient.

[Daytonite, BSN, RN]

runningwithscissors. . .here you go. here's the information right from medicare on reporting fraud, which is what you are describing.

http://www.medicare.gov/fraudabuse/howtoreport.asp - how to report medicare fraud

by phone: 1-800-hhs-tips (1-800-447-8477)

by fax: [phone]

(no more than 10 pages please)

by e-mail: [email protected]

by mail: office of the inspector general

hhs tips hotline

p.o. box 23489

washington, dc 20026

i am an rn of 30 years who is back in school studying health information management. medicare is something we study about all the time in the program. all hospitals have systems in place that you are mostly likely unaware of (i know i didn't know about them until i started studying health information management). these systems address all the issues you've listed. medical necessity is addressed by either a utilization review or quality assurance committee (the qa committee that is a medical staff committee, not a hospital administrative committee). peer review activities by your hospital's organized medical staff should pick up on any physician who is abusing facility resources. this peer review is a medicare mandated activity. and, if the hospital is failing in catching these things, medicare has a state agency in place in all states that monitors all the peer review activities to make sure they are performing their duties up to snuff. you also need to know that once a physician is given privileges on the medical staff it is like pulling teeth to get rid of a bad one and it can take a few years to successfully accomplish it. many people have to be involved in collecting and documenting their shenanigans to get them off the staff. it's not like firing an employee. if there are people in the medical staff services office who are not savvy at how to do this or the chief of staff or chief of a physician's medical specialty service isn't inclined to help out, a jerk of a physician can remain on staff for a very long time. you also need to know that the medical staff has equal power with the ceo who represents the board of trustees. the ceo has no power over the medical staff. the medical staff is directly responsible to the board of trustees for their actions. they are an organized group, by both state and federal law, with bylaws that govern and bind their membership as doctors with privileges in your hospital. (if only nurses had organized as well as the docs did years ago, we'd be so much better off!)

if you believe that medicare abuse is going on and not being given any attention then report it to medicare. you have the numbers and addresses now. go for it. please let us know how it turns out.