This just gripes the crud out of me...

[AngelfireRN]

Y'all feel free to tell me if I'm awful for feeling this way. I've just seen so much of it lately, I'm sick.

Had one today that absolutely tipped my control balance.

He came in a few days prior, saying that he HAD to see the doc about 'his breathing'. We had no appointments, and he was not in distress at that time, so we made him an appointment for today, and I pulled the chart for review before he was to come in. There was no mention in any previous visit of any pulmonary dysfunction, and also nothing related to lung issues on the medical history form he filled out on his inception to the clinic. No treatment for breathing trouble, nothing.

He came back in, and I questioned him about the complaint.

"Well, I'm filing for my disability, and I want to put my breathing for part of my disability, so my lawyer told me to get to my doctor and get put on treatment."

"I see. And how long have you had this trouble?"

"Oh, YEARS. I've been using my brother's meds, and they really help. I have an awful time."

"Where have you been treated before, and do you remember who treated you and with what?"

"No, no one ever treated me. I just tried my brother's squirter and that stuff you put in that pipe."

"So, no diagnosis of asthma, COPD, emphysema, or anything like that, ever?"

"No, but my lawyer said I needed to get put on treatment so I could claim it on my disability application."

All of this, with no notable SOB, and a pack of Marlboros in his shirt pocket.

"OK, the problem is, sir, you have never mentioned that you have breathing trouble, nor did you list it or any medications that you take for it on your medical history. So, with you admitting that you're only seeking treatment on your lawyer's advice so that you can claim this on your disability application, it looks, well..."

"Suspicious?"

"Exactly." ( My patient's number one compliment about me at this clinic is that I DO NOT LIE to them. Not about anything. This guy was not going to get a candy-coated version, either.)

So, we did some tests, O2 sat normal, lungs clear, PFT normal as could be. The most telling thing, after Doc and I reviewed the tests, and I told him that they were normal, he got irate.

"I DO!!!! I DO have trouble breathing! My work told me that 3 years ago! They said I had the lungs of a 90 year old! They gave me antibiotics! I DO have trouble breathing." All this at the top of said 'terrible' lungs, with not a cough or a wheeze to be heard.

He got a script for a rescue inhaler, and a refusal for an early refill on his pain meds, and stormed out in a snit.

Call me heartless (really, go ahead, seems to be the going thing, lol), but I refuse to lie about anyone TO anyone so that they can cheat the system. I have to go to work every day, regardless of whether I feel like it or not, and I expect every able-bodied person to do the same. And the disability attorney will request the test results, and have a review team see that they were normal as well, so my lying and prescribing unnecessary meds would not have helped in the long run, even if I were unethically inclined.

I guess it gripes me that some of my poor little elderly patients have worked all their lives, only to be unable to get disability for a legitimate complaint, and here's this clown trying to get a free ride.

Thoughts?

[xtxrn, ASN, RN]

Did you ever go to the doctor and say "I have trouble breathing and my lawyer says I need you to document it so I can get my disability?" Then she's not talking about you, nor is anyone else.

Understood. :) It was getting rather general in several posts. That's all

[xtxrn, ASN, RN]

as soon as you find out how, i wish you'd tell me. i documented the whole incident, which made him even madder. now it part of his chart, and it's considered a legal document. and it says everything that transpired. in detail.

social security administration: 1-800-772-1213 (another computerized system) website: http://www.ssa.gov (there should be fraud information/reporting guidelines there)

centers for medicaid/medicare services.....1-800-medicare that's 1-800-633-4227 (seriously, that's their number). i don't have the cms web address available right now , but i'm sure it would be easy to find, and probably faster than the phone lunacy.

and, they're pain in the butt computerized systems, but a human does eventually show up. i've called them myself, on my own explanation of benefits when something didn't look right... (one diabetic supply place i hadn't used in years tried to bill for supplies).

i do get a bit testy over what feels like blanket statements- (sorry )

but i can't stand fraud even more.

[xtxrn, ASN, RN]

I can't speak for all disabled persons everywhere, and I'm not trying to.

This post was about one case that starched my Underoos, no more. I didn't generalize, and I didn't call names to anyone except the original guy.

If you want to make it personal, that's your call. But my statements are about the case I started with.

I know not ALL disability cases are not scams. I know MCD is not easy street. I see it every day. Trust me, I know.

I apologize for getting my underoos a bit tight

I understand (and agree with just about everything on this thread). It does feel a bit attacking at times, and I'll do better not taking it so personally in the future. It bites to be in the same "general" category as the despised folks , and collect what they are aiming for.

I am p-o'd about the guy you had to deal with. That stuff does need to be stopped.

[AngelfireRN, MSN, RN, APRN]

To be honest, I'm surprised he hasn't been back in, claiming an exacerbation or some such. With this particular one, that's about par for the course.

Actually, with quite a few where I work, it's something akin to dealing with a small, recalcitrant child. If they don't like the answer they are given, they try again, each time with a different tack, for a different outcome. Thankfully, we see them coming a mile away and can usually head it off, the clinic as a whole is very good about 'having each other's back' in cases like that.

In regard to reporting, can it be done anonymously? I mean, yes, I'd have to be involved to know what I know, but I also don't want to violate HIPAA, even to prevent a potential fraud.

[JeneraterRN]

In regard to reporting, can it be done anonymously? I mean, yes, I'd have to be involved to know what I know, but I also don't want to violate HIPAA, even to prevent a potential fraud.

I wonder about that as well. Say, for instance, they wanted to prosecute this individual. That would highlight your actions, which could be potentially illegal by breaking confidentiality, or inadmissible because it was illegally obtained. It would be nice if his lawyer requested an opinion with his consent, and you could get him that way.

[JeneraterRN]

You know, Medicaid is privy to his info. He's attempting to defraud his insurance and disability. Just a thought.

[Lifeofanurse]

So why did he get a script for a rescue inhaler?

So when he pulls a "slip and fall" act in the middle of Walmart...and claims it was because his dr/clinic refused to issue him medication for his 'breathing problems'...he got SOB, got dizzy and fell.

So then he sues... you, the dr./clinic. AND walmart.

Better to give him the inhaler...and put it on the record as at the pts insistance/request for unobserved SOB. Document all the test results...and sleep well knowing you won't be in court. fighting his latest scam for a free ride.

[AngelfireRN, MSN, RN, APRN]

Life, that made me laugh...thank you. And I would not put it past a few at our clinic to do just exactly that.

[rngolfer53]

If there are lawyers involved, lying will be involved in short order.

[redhead_NURSE98!, ADN, BSN]

If there are lawyers involved, lying will be involved in short order.

That's not a very nice generalization.

[AngelfireRN, MSN, RN, APRN]

No, but unfortunately, in today's society, it's a very apt one. Not all lawyers are fit for that category, but we all know that there are ambulance-chasers all over.

I believe that's what was meant.

[VivaLasViejas, ASN, RN]

We have a youngish resident at my ALF who's a lot like the patient in the OP. He finally got caught hiding income and got booted off Medicaid, but while he was on it he loved to remind my staff that "I pay your salary, you know!"

One day, I heard him say that to my day-shift supervisor, and it was one time too many. He's alert and oriented, and contrary to his belief, being a resident doesn't grant him the privilege of behaving like someone who's 85 and demented. I shook my finger at him and said, "Excuse me, but NO, you don't pay her salary, in fact, she makes ten bucks an hour and pays taxes so YOU can afford to live here." That shut him up sharp, and now that he pays his own rent and service charges, he doesn't talk like that anymore. He's lucky he's not in jail for Medicaid fraud......at least, not yet.

Look, I'm not against Medicaid or the average Medicaid patient, as long as they are in genuine need. I was one myself, and I was thankful the help was there for me when I was raising small children. But it infuriates me that cheaters, like the OP's patient and this ass clown at my facility, so often get away with draining what limited Medicaid funding is available. They make it so that people like my sister, who became disabled at age 58, have to do without health care because their monthly SS checks give them "too much money" to qualify, even though they are well under the federal poverty lines. Makes me mad enough to bite a rock.