topic Re: What A Flipping Racket. in Wellness

What A Flipping Racket.

CrazyKittyLvr2 — Wed, 01 Apr 2020 18:52:42 GMT

When I had my TKR on 11/20/2019, of course I couldn't drive as it was my right knee. I had a home health woman come very other day for 2 weeks. Plus 1 day the 3rd week.She did the BP, checked my incision etc. The 1st day she gave me exercises to do.

I did not go to outpatient PT because the place I wanted to go had a fire and were shut down. The only other option was where I did my pre-op PT when I had my hip done in 2018. I was not impressed with them at all.

My Dr. said I could just do my exercises at home.

Anyway, I got a Summary Notice (for Part A Hospital Ins) from Medicare. For 7 visits in which I didn't do any exercises with her here was $2,750.00. Oh,she watched me do the stairs once.

I did the exercises 3 times a day, morning,noon and night. She came between the morning and noon times. Was here maybe 1/2 hr. and then left. 3 and 1/2 hours total time over 2 weeks and 1 day.

I was in the wrong line of work before I retired.

Re: What A Flipping Racket.

on the bay — Wed, 01 Apr 2020 19:35:18 GMT

@CrazyKittyLvr2 -

I'm sure that is how they get lots of money by putting things, supplies, treatments in that were never done.

some is routine, like something they may put in every room, or assume is done with every respiratory therapy etc.

It is also amazing how if you are able to read doctors notes on a visit, how many things that are just false and you never said or had done!

My mother is maybe one of few who do this, but she actually goes over every line of the bill and calls and disputes it if she didn't think she got it or it happened. And she doesn't pay for it because she has medicare and great insurance, only copays.

She catches a lot!

It really is awful.

Re: What A Flipping Racket.

Kachina624 — Wed, 01 Apr 2020 19:13:55 GMT

Medicare reimbursements are so low, providers have to cheat in order to break even. I can't believe how little they pay a doctor.

You have the right to protest any illicit billing. I believe Medicare encourages you to do so.

Re: What A Flipping Racket.

Group 5 minus 1 — Wed, 01 Apr 2020 19:15:11 GMT

Years ago and I mean years we had a patient who recorded (in a notebook) the amount of time her doctor spent on a hospital visit,when she got the bill she told him and not quietly that she did not consider poking a head in your room and saying "Hi" a hospital visit.

Re: What A Flipping Racket.

HerRoyaLioness — Wed, 01 Apr 2020 19:20:11 GMT

What was the Home Health persons's status? CNA, LPN, RN, Physical therapist?

It can make a difference in the billing.

If she touched you, took vitals and gave you exercises, it can be billed, but it depends how they billed it, as a home health visit or PT visit?

It sounds like this was being done in your home? Then Medicare Part A shouldn't be billing you if the place of service was at home.

I would call and ask about this.

Re: What A Flipping Racket.

Mom2Dogs — Wed, 01 Apr 2020 19:29:34 GMT

My mom was a nurse and always said if you are ever hospitalized go over the bill with a fine tooth comb. I had an outpatient surgery years ago and did just that. The charge I found and called about was legit but I didn't know what it was, and sounded off to me.... and wanted to know before I paid for it.

DH is on Medicare and we carefully watch those bills and match them up with the actual bill from the facility.

Re: What A Flipping Racket.

Maltichonmom17 — Wed, 01 Apr 2020 19:40:55 GMT

Questionable insurance billing has been going on for quite awhile unfortunately. Back in the 90s during the HMO insurance era, I had a new doctor and my first visit was a sick call. I had the flu and then started having econdary respiratory complications. At his office, he literally did nothing but take my BP and listen to me breathe. I was there maybe 10 minutes. He said I had pneumonia, handed me a prescription and sent me on my way.

A few weeks later, I received an itemized statement from the insurance company detailing numerous diagnostic tests and X-rays that this doctor had supposedly performed. I called my insurance company and alerted them to the fact that none of the testing he was billing them for had happened. The person I spoke to thanked me for taking time to report it and then explained that while they knew these things were happening quite often, it was more cost effective in the long run for the insurance company to overlook the deception and just pay the bill than to investigate it. I was just stunned.

Re: What A Flipping Racket.

lovemyparrot — Thu, 02 Apr 2020 21:42:46 GMT

Hi, OP, if you are a retired legal secretary (as I am), you will know how many items on a bill from an attorney are added in, how many phone calls you made on behalf of the attorney, how many legal documents you drew up and produced for the attorney to quickly scan through and sign, and on it goes.

Yes, its a racket, but not unusual at all in the health industry, legal services and lots more.

Re: What A Flipping Racket.

tsavorite — Thu, 02 Apr 2020 22:05:10 GMT

@Maltichonmom17 wrote:
Questionable insurance billing has been going on for quite awhile unfortunately. Back in the 90s during the HMO insurance era, I had a new doctor and my first visit was a sick call. I had the flu and then started having econdary respiratory complications. At his office, he literally did nothing but take my BP and listen to me breathe. I was there maybe 10 minutes. He said I had pneumonia, handed me a prescription and sent me on my way.

A few weeks later, I received an itemized statement from the insurance company detailing numerous diagnostic tests and X-rays that this doctor had supposedly performed. I called my insurance company and alerted them to the fact that none of the testing he was billing them for had happened. The person I spoke to thanked me for taking time to report it and then explained that while they knew these things were happening quite often, it was more cost effective in the long run for the insurance company to overlook the deception and just pay the bill than to investigate it. I was just stunned.

Wow....what would have happened if you had gone to have a chest x-ray a few days later somewhere else? wonder if that claim would have been denied due to the previous doctor submitting flase charges for x-rays.

Re: What A Flipping Racket.

mousiegirl — Sat, 04 Apr 2020 00:18:58 GMT

@CrazyKittyLvr2 When I had my hip replacement twenty-three years ago, my doctor didn't believe in PT, so had me do exercises from bed, free, and no stress for me.

It is shocking what the medical profession charges, even took my own meds to the hospital once, and was told that I may as well take theirs as I would still be charged. Next time, if any, hope not, I will take mine and not tell anyone, just sneakily take them.

Re: What A Flipping Racket.

KarenQVC — Sat, 04 Apr 2020 02:18:32 GMT

I worked a few years as a home care social worker. Yes, Medicare paid in the hundreds for my visits.

What you should know is that it is a terribly inefficient job. The only people who were able to earn the big bucks were some of the PTs who just ran through the days knocking off quickie visits.

The nurses and social workers were doing much unseen work for patients and the system--consultation with other professionals, documentation, staff meetings. These in addition to the endless driving, driving--especially in bad weather.

Yeah, home care saves Medicare with fewer repeated hospitalizations, but it is not much of a racket for the staff.

Re: What A Flipping Racket.

conlt — Sat, 04 Apr 2020 17:21:48 GMT

I am a home health nurse for 39 years. There has been much fraud over the years but I can tell you it is not the clinicians who are making big bucks. Medicare has changed the payment system several times since I have been in home health. In fact they changed the payment system in January 2020. So payment would depend on when your services were, If they were after January 1st then the company got paid by the new payment system.

In the old system the company got paid a lump sum of money based on the assessment of the patient, the diagnosis, and the number of therapy visits that the patient needed. If the agency did at least 5 visits within the 60 day period, the agency received the full lump sum payment. The only thing that altered the amount of that payment was therapy visits. So say for nursing, if the company did 5 nursing visits they got say $3000 but if they did 10 nursing visits they got the same $3000. They have to pay the clinicians and the expenses. If therapy was put in on the case, payment could raise to up to about $6000 for a 60 day period of time.

In the new payment system the agency gets paid only based on the actual condition of the patient based on the assessment and diagnosis. The payments are split into 2 months and each month the agency has to do a certain number of visits in order to get full payment for that month. The number of visits for full payment varies between patient to patient, based on the patients condition. I like the new system better.

Personally, I worked for a non profit for many years and they sold us to a for- profit company. That company was great, they always told us to take care of the patients. A few years ago we were sold to another for- profit company unfortunately, they were not about the patient and I was uncomfortable. I no longer work there, but work at another company now. I always made sure our patients were taken care of

A total knee patient does not need much. Most of the time the physician has a specific protocol that dictates the number of visits for these patients. Many times it is 5-7 visits. The therapist needs to spend at least 1/2 hour with the patient but a good therapist would spend about 45 minutes.

I am a nurse, I have a Masters Degree in Nursing. It took me 6 years of college to reach that level and I had to pass a State exam to practice. Medical professionals need to get paid fairly for their expertise. What would we do without them? Look at our world today, medical professionals are finally recognized for the heroes that we are.

I am so sorry you had a bad experience in home health. There are those companies out there. You have a right to chose the company that you want. Medicare.gov home health compare data can help you decide.Next time, look at the data and ask your doctor for the agency that you choose.