Medicare Screwed? Fraud? Just Another Day in California Medical System!

A story for you that is hard to believe. It starts sad and then it becomes really ugly so stick with me until I get to the point. My mom died in April and of course, lots of malpractice, incompetence, ignoring power of attorney, wrong drugs without permission, etc. These stories for another day but I now want to introduce you to another subject.

My mother belonged to a large HMO through a major senior organization in Southern California–not giving names but I am sure you know what I am talking about. Few seniors do not belong to this HMO. After my mom died and I received all the medical records from all the hospitals, skilled nursing, etc.,  (for a lot of money mind you!) I started to suspect that something is not right.

Today I received a call from another woman who went through the same thing–with the same hospital in one case–with the same outcome: dead mother for no reason. She had something I did not have: Medicare summary copies of medicines and treatments her mother received so she could see that there was fraud. The hospitals charged Medicare for things her mother (blind and demented) could never do, medications she never got, etc.

She tried everything and though she could not break the system, she educated me on what so far she has learned. Well. Let me tell you this is not pretty!

On her urging I called the Senior Medicare Patrol in Orange County who dutifully will investigate all charges that were submitted by individuals to examine hospitals and medical providers in what they submitted to Medicare and then compare those with the data files of the patients to find discrepancies–sort of like a Medicare watchdog. Awesome. Great service! So after we talk, I called Medicare and gave them my mother’s information and asked them to send me the medicine and treatment records they have from the hospitals so I can compare what she got versus what was claimed on the medical records and then, like an autumn fly, I hit the hard wall of stupidity.

I call it ADA, short for “absolute dumb act,” on the part of both Medicare and also on the part of the California legislature.

First let’s look at Medicare’s dumb act: when someone dies, Medicare immediately purges all records so there is no chance in heaven or hell to find out what medications and treatments were claimed by hospitals or doctors and what the deceased actually received. This is an amazing opportunity for fraud and I bet your pants off that there is plenty of fraud as a result. There is just simply no way to check who received what and what was claimed–this is invitation to cheat as you like.

Dumb act two is even dumber: HMOs file to Medicare in “bulk” meaning that if they have 15 patients who receive morphine, they will bill Medicare for 15 doses of morphine but Medicare will have no clue who actually received that morphine–perhaps no one did! So in theory, any HMO hospital or medical center can claim any amount of any expense of any drug given to any patient for reimbursement that they have never ever given to anyone

Are you angry? You must be! It is your money these HMOs are taking! It is your tax dollars they are spending–no wonder our government is bankrupt! I will open my window and yell as “I am mad as hell and will not take it anymore!” until I can get the ears of someone who can help me change the system!

If you have information of any kind that is helpful so I can start breaking the system down, please send a note, email, comment, whatever. I want this ADA to end!

Angela

About Be Healthy

Angela A Stanton, PhD, is a Neuroeconomist who evaluates changes in behavior, chronic pain, decision-making, as a result of hormonal variations in the brain. She lives in Southern California. Her current research is focused on migraine cause, prevention and treatment without the use of medicines. As a migraineur, her discovery was helped by experimenting on herself. She found the cause of migraine to be at the ionic level, associated with disruption of the electrolyte homeostasis, resulting from genetic mutations of insulin and glucose transporters, and voltage gated sodium and calcium channel mutations. Such mutations cause major shifts in a migraine brain, unlike that of a non-migraine brain. A non-migraineur can handle electrolyte changes on autopilot. A migraineur must always be on manual guard for such changes to maintain electrolyte homeostasis. The book Fighting The Migraine Epidemic: How To Treat and Prevent Migraines Without Medicines - An Insider's View explains why we have migraines, how to prevent them and how to stay migraine (and medicine) free for life. As a result of the success of the first edition of her book and new research and findings, she is now finishing the 2nd edition. The 2nd edition is the “holy grail” of migraines, incorporating all there is to know at the moment and also some hypotheses. It includes an academic research section with suggestions for further research. The book is full of citations to authenticate the statements she makes to be followed up by those interested and to spark further research interest. While working on the 2nd edition of the book she also published academic articles: "Migraine Cause and Treatment" Mental Health in family Medicine, November 23, 2015, open access "Functional Prodrome in Migraines" Journal of Neurological Disorders, January 22, 2016, open access "Are Statistics Misleading Sodium Reduction Benefits?", Journal of Medical Diagnostic Method, February 3, 2016, open access “A Comment on Severe Headache or Migraine History Is Inversely Correlated With Dietary Sodium Intake: NHANES 1999-2004” Angela A Stanton PhD, 19 July 2016 DOI: 10.1111/head.12861 not open access, subscription is required to read it. Dr. Stanton received her BSc at UCLA in Mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford University, PhD in NeuroEconomics at Claremont Graduate University, and fMRI certification at Harvard University Medical School at the Martinos Center for Neuroimaging for experimenting with neurotransmitters on human volunteers. For relaxation Dr. Stanton paints and photographs. Follow her on Twitter at: @MigraineBook
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5 Responses to Medicare Screwed? Fraud? Just Another Day in California Medical System!

  1. How very interesting and disgusting Angela, you sure are amazing, I admire the work you are doing here..hope it helps…
    Sherri

    Liked by 1 person

    • Thanks Sherri and thanks for the re-blog. I hope I will be able to turn the medical system around… It will be hard work and cannot do it alone but by gully I will give it my best try! ❤

      Like

  2. Angela Grant says:

    Angela I think the clueless people are not doctors but rather patients. Clueless patients trust our medical system. provides care. Clueless patients have not discovered the deep depths of corruption and incompetence baked into our medical delivery system. A system culturally incentivized for more fraud and abuse by quacks such as Sunil Shroff, MD at Tufts Medical Center and Alice Newton, MD at Boston Childrens now promoted to MGH.

    The doctors are being paid quite well by patients (US). As a matter of fact, hospitals and their staff are being given more POWER so I would say we are clueless in letting this continue.

    Everyone should take care of her health and pray never to need the services of our medical system.

    Liked by 1 person

    • Totally agree Angela. I titled the blog clueless doctors to bring attention to the cluelessness of the doctors to themselves! The final book will mostly be educating the public. There will be some stories on how and why doctors are clueless. Not all doctors are so though but the gems are very hard to find.

      But listen to this: I filed a complaint against a doctor that the state licensing investigator of a skilled nursing found by accident to have lied to them about how I approved something–no paper trail of course, since I never approved it–so in the process I found out that this “doctor” does not even have a license to practice! Now we are not talking about a small unknown medical facility here but one of the biggest ones in the state! So I filed a complaint with the CA Medical Board and they “confirmed” that they received my complaint against the doctor under whose license this guy was pretending to be a doctor and not this guy! I just wrote them a letter by fax (for the paper trail) back to the Board that oh no you don’t!!! I want the complaint against BOTH doctors since both have committed a crime! They both better end up without license forever and the one prescribing without license better be having visiting hours in jail!

      So while the general public is clueless about the medical field’s incompetence, the medical field is also clueless and is criminal in more ways than one. All this and more in my book! (I am mad as hell in case you cannot judge from my tone of voice! Grrrrrrrrrrr)

      Liked by 1 person

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