Cost Shifting, Defensive Medicine, or Simply Waste, Fraud, and Abuse?

My father died in September of 2009 from Alzheimer dementia.  In the last year of his life there were three separate occurrences of others cashing in on Medicare by virtue of his situation, that I contend would not have happened under different circumstances.

Let’s look at these situations starting with September 2008 when my father still had a year to live.  The assisted living facility where he resided called me one morning to say that dad was really in poor shape, not responding well and should go see his doctor as soon as possible and I should take him there.

They were certainly right.  I found him unable to walk on his own.  Wheelchair to the car to wheelchair to the doctor’s office, I got him there.  The doctor examined the old man and concluded that the end was fast approaching and I should get hospice involved.  He added that all medications would be stopped and he would not be seeing him again, that the end would come quickly.   OK, so I returned dad to the facility and contacted hospice as instructed.

Four days later and having been off all medication something amazing happened.  There my father was, able to carry on a conversation and better than I had seen him in at least 6 months.  It sure looked like the medications were to blame, and in itself, is another story.  This vastly improved condition lasted several more months and it quickly became apparent that he was not about to die anytime soon.

The problem is that hospice, now engaged and entitled to six months worth of payments from Medicare did not remove themselves from the equation.  They still sent staff around but largely were not needed.  This continued for the entire six month period.

Time went on and as dad’s condition deteriorated toward the real end of his life the connection between the brain and the muscles weakened and he became a fall risk.  Since government regulation forbids strapping him into his wheelchair, he fell.  Twice when he fell he must have said “ouch” and he was whisked off to a local hospital and I was notified and met him there.

On each of these two occasions, upon examination, no reaction of pain whatever could be found.  The man was clearly not injured but highly stressed due to the deepening dementia and the strange surroundings.  Yet each time, with no discussion whatever, dad was wheeled down the hall for an MRI for which the hospital collected $1150 from Medicare.

So there it is, the first instance being rather clear, but what about those last two?  Cost shifting, defensive medicine, or simply waste, fraud, and abuse?  I’ve wondered about that since, but I do know the one thing that would have gotten in the way of any of the nonsense I witnessed.  And that would be paying directly rather than through a third-party.  Questions of necessity would have been asked.  Would a simple x-ray be sufficient for the circumstances?  A requirement to check off on declined services may have occurred, but they would not have happened.  This is just one example of the waste via overuse caused by unnecessary third-party payment.  With the illusion of free, no one was asking questions.  No one cared.

The lack of scrutiny on the part of Medicare is also a question.  Does it matter that claims may be processed cheaper if the eyes are shut?  Indeed it is the  profit motive itself that serves to apply the brakes to such behavior in the private sector.  Fear of loss, the other side of the profit coin, demands forces for efficiency that are not there without it.  Three occurrences in one year with one patient begs the question, “how many times is this repeated day after day after day after dollar?”  Isolated instance?  Of course not.  Advocating for single payer government (Medicare for all) is a recipe for disaster.

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