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