Just a “little” medical fraud

An elderly friend recounted this story to me. He’s upset. I’m upset. And I expect by the time we’re finished, the doctor will be more than a little upset, too.

Mr. Z is 90 years old, and except for macular degeneration which renders him mostly blind, he is very healthy and quite sharp. He lives by himself, but gets along and around quite well.

Last week, Mr. Z went to his podiatrist to get his toenails clipped, and when the doctor was finished, he exclaimed, “There you go, Mr. Z. Your corns are all taken care of.”

“Corns?” asked Mr. Z. “I didn’t have corns– all you did was clip my toenails.”

“Sure — you have corns!” Mr. Z was told. “Otherwise you’ll have to pay me out of your pocket!”

By the time Mr. Z returned to his apartment, he had figured out what it was all about. And he was upset. That’s why he told me the story. He realized the podiatrist was going to bill his insurance, or perhaps Medicare, for a procedure he didn’t really have. It made him mad.

Do you know who DID pay for that toenail clipping AKA corn repair? You did, and I did. Mr. Z surely didn’t pay for it, and the podiatrist probably made twice as much money on the transaction than he would have made had Mr. Z written a check. No doubt insurance and Medicare (maybe he billed them both!!??) pay more for corn repair than an individual pays for a toenail clipping.

As smart health and medical care consumers, we must be watchful when doctors and facilities get reimbursed for the work they do on us. If we were writing checks, or paying cash from our pockets, no doubt we would review billings carefully. But with insurance or Medicare as a middleman, it’s easy to let it go. That is one reason, of course, why insurance prices just continue to go up and up.

And when you find a discrepancy? Start by checking with the doctor or facility that was reimbursed. Give them a chance to explain it to you, or to change it.

If you feel they are trying to do something illegal, report it to the payor — your insurance company or Medicare. Here’s a link to the Medicare fraud reporting agency.

Do you want to pay for work that wasn’t done? Do you want to pay for everyone else’s healthcare? Does this make you as mad as it makes me?

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1 thought on “Just a “little” medical fraud”

  1. I went into a local hospital for surgery and it went unusually well. They even said I could bring in my own meds and just show them to the nurse. This was all okayed before I went. Well I did show the meds and she told me to just put them in my drawer and just let the nurse know what I took..Well, other than a single shot of pain killer after my recovery, I took my own moetrin and my usual meds..My nurse came in and asked what I had taken. I started to tell her about the supplements but she said she just wanted to know my regular medicines..like prozac, etc..so I told her..WEll when my bill went to my insurance ,they billed for all the prescription meds.
    When I called to have an adjustment, they first said I probably dont remember them giving me those drugs..I said I know what I brought with me and that is what I took..Well I kept calling and checking and even called the insurance company who offered that they may order drugs for my chart for the day I went into the hospital and if I didnt take them, they have to dispose of them so they have to pay. I tried to clarify that I had talked to them before hand about me taking my own meds and that they in fact offered that option to me. Then the nurse came in and only asked if I had taken anything from my meds and wrote it down in her chart.. I also mentioned that I told her I took vitamin C and a couple other items but she never charted those,they were only interested in billable items. I thought a chart was supposed to be so they know incase you have a reaction or something unusual happens while your in the hospital? I called back the hospital who offered to take it off the bill if I could prove that I did infact took my own meds and not take the hospitals meds?? That really made me angry.

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Trisha Torrey
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