Free by-pass surgery--whether you need it or not!

Today the Lexington Herald-Leader reported:

"A southern Kentucky hospital will repay $16.5 million to the federal government to settle claims that it submitted false or fraudulent Medicare and Kentucky Medicaid claims for completing surgeries to implant unnecessary coronary stents and pacemakers and perform coronary artery bypass grafting.

The agreement released Tuesday by the U.S. Attorney's Office in Lexington covers a period from Jan. 1, 2008, through Aug. 31, 2011 at Saint Joseph Health System, which runs Saint Joseph London Hospital. The agreement also covers allegations that the hospital, which serves a primarily rural swath of counties near the Kentucky-Tennessee state line, violated a federal anti-kickback law by entering into a sham agreement with a clinic in the area."

Fraud? Kickbacks? 2008, before AHA? Unnecessary open heart surgery? just to increase revenues?

I hope your wife or mother is not one of those that died...needlessly...padding the bill.

Regardless of your politics, we have to do something to control healthcare spending in America...including this kind of pure fraud....by the doctors we too often worship.

One guy did not do this alone...it was a group effort.

(quoted from post at 20:24:13 01/28/14) Today the Lexington Herald-Leader reported:

"A southern Kentucky hospital will repay $16.5 million to the federal government to settle claims that it submitted false or fraudulent Medicare and Kentucky Medicaid claims for completing surgeries to implant unnecessary coronary stents and pacemakers and perform coronary artery bypass grafting.

The agreement released Tuesday by the U.S. Attorney's Office in Lexington covers a period from Jan. 1, 2008, through Aug. 31, 2011 at Saint Joseph Health System, which runs Saint Joseph London Hospital. The agreement also covers allegations that the hospital, which serves a primarily rural swath of counties near the Kentucky-Tennessee state line, violated a federal anti-kickback law by entering into a sham agreement with a clinic in the area."

Fraud? Kickbacks? 2008, before AHA? Unnecessary open heart surgery? just to increase revenues?

I hope your wife or mother is not one of those that died...needlessly...padding the bill.

Regardless of your politics, we have to do something to control healthcare spending in America...including this kind of pure fraud....by the doctors we too often worship.

One guy did not do this alone...it was a group effort.

Click to expand...

EDD if you pay attention every couple of years they catch someone defrauding the system. FL has had a long standing problem with it and Medicare patients. Most often the doctors are involved in it too, so it's not just the clinics and hospitals.

The AHA isn't going to stop that and may actually cause a rise in it as they dictate lower payments for medical care. That's going to make it easier to get doctors to go along with scams just because they will think they deserve more. I think the problems will grow but because some will be fraud against the government, some insurance fraud and some against the states it's going to be harder for them to catch it.

It seldom is just one guy.

Rick

I fear this happens more often than we think. A few years back in Redding CA they had a scam going on, they targeted anyone passing by on I5 that went to the Emergency Room that had any symptoms of a heart attack. Gas, short of breath, heartburn, cheast or arm pain, ect. They told the patient (victum ?) that they would not make it home, they would die without surjury, right away. Now, it is really easy to have excellent outcomes on heart opperations done on healthy hearts and healthy people that that just ate to spicey of a meal. And I may add, hospitals are ranked by outcomes. Everyone wants to go to the hospital with the best outcomes. If they only opperate on healthy people they are going to be seen as the best. And who would complain ? The Dr said I was going to die, he did the opperation, and I am as healthy as can be. Except they were as healthy as can be before they met that Dr. One day though some guy declined treatment, and drove to the hospital in Concord CA. The ER Dr and the Cardiologist heard the mans story and went nuts, and started screaming to the Mediacal Board and Attourney General. His heart was fine, no 98% blockage. That was the downfall of that scam. To help avoid this, my suggestion as a Paramedic, see your Dr/Nurse Practioner every year and discuss if he/she thinks you need a treadmill. I heard way to many guys pledging healthy habits, loose weight, quit smoking, exercise, eat right, ect when they were looking at the ceiling of the ambulence.

(quoted from post at 23:37:17 01/28/14) I fear this happens more often than we think. A few years back in Redding CA they had a scam going on, they targeted anyone passing by on I5 that went to the Emergency Room that had any symptoms of a heart attack. Gas, short of breath, heartburn, cheast or arm pain, ect. They told the patient (victum ?) that they would not make it home, they would die without surjury, right away. Now, it is really easy to have excellent outcomes on heart opperations done on healthy hearts and healthy people that that just ate to spicey of a meal. And I may add, hospitals are ranked by outcomes. Everyone wants to go to the hospital with the best outcomes. If they only opperate on healthy people they are going to be seen as the best. And who would complain ? The Dr said I was going to die, he did the opperation, and I am as healthy as can be. Except they were as healthy as can be before they met that Dr. One day though some guy declined treatment, and drove to the hospital in Concord CA. The ER Dr and the Cardiologist heard the mans story and went nuts, and started screaming to the Mediacal Board and Attourney General. His heart was fine, no 98% blockage. That was the downfall of that scam. To help avoid this, my suggestion as a Paramedic, see your Dr/Nurse Practioner every year and discuss if he/she thinks you need a treadmill. I heard way to many guys pledging healthy habits, loose weight, quit smoking, exercise, eat right, ect when they were looking at the ceiling of the ambulence.

Click to expand...

Funny thing about that treadmill. It was a standard test for any active duty Army guy to have to do that at age 40. The Army then decided that NG and reserves do the same. I heard that out of the first 5 guys in the NG and reserves that 3 hit the floor dead and they stopped the test at that point.

Kinda funny now but a few years ago my wife thought that she was having heart problems. I knew it was just stress but to be on the safe side I took her in. They couldn't find anything but decided to do a stress test. The day of the test we went in and she did the test. She came out of the test very happy because of the results (doc told her everything was fine) but laughing too. He was shocked. He told her that she was the first woman he had tested in years at her age who wasn't over weight. Mind you that she has never smoked but me, at the time had done the age 40 tread mill stress test and passed with flying colors as a 2 pack a day smoker.

Rick

i just had surgery 67 bucks for a sling the shop rag would have worked .maybe it was a guy who made the bikini charged like it how did grandma say it the smaller it got the more costly it got

(quoted from post at 22:24:13 01/28/14)
Regardless of your politics, we have to do something to control healthcare spending in America...including this kind of pure fraud....by the doctors we too often worship.

One guy did not do this alone...it was a group effort.

Click to expand...

On Yahoo News, today: "Snakebite victim charged $89,000 for 18-hour hospital stay.........According to his bill, the hospital charged a whopping $81,000 for a four-vial dose of the medication. For comparison, Ferguson and his wife found the same vials online for retail prices as low as $750."

Hmm, your Kentucky doctors sound like small-time operators.
Michigan cancer doctor

People need to start rethinking this whole "health care" thing. It's not "health care", much less "health insurance". What it is is the "Medical/Pharmaceutical/Hospital INDUSTRY". It's better than 1/6th of our economy. Our Medical Industry kills thousands, maybe tens of thousands each year and rarely is anything even said, much less brought to court. People will sue for a botched nose job but never say a word when people are over prescribed meds, given useless tests, complaints ignored or either forced to stay in a hospital or not admitted. It's a giant, incredibly lucrative industry. And there's not much we can do to fight it.

Find a decent, honest doctor is you can. Treat him right and hope he does the same for you. When he starts building the new million dollar house, his days of honesty are numbered.

What is AHA? I assume American Heart Association? How does the American Heart Assoc. dictate lower payments for medical care?

I stumbled across a website(don't remember what its called) that listed the fraud that is going on in illness management system. It is updated daily and the list is endless. Not just hospitals and dr.s but nursing homes and pharmacy.

(quoted from post at 05:15:59 01/29/14) What is AHA? I assume American Heart Association? How does the American Heart Assoc. dictate lower payments for medical care?

Click to expand...

John, I dropped the C sorry AHCA Affordable Health Care Act.

Rick

This guy should add you to his cabinet. Every year the two of you can tell the world that neither of you opened gitmo, but both promise to close it down by the end of the year. "If you don't like your gitmo, you won't keep it. If you don't like your cell guard, you won't keep him. Promise, guaranteed".

Mark

Funny, but I sort of see the discussions on YT Mag as a reflection of the way Americans think.

If someone posts about Propane prices, or Diesel fuel cost increases, the price of parts at the JD dealer, or the price of rake teeth at TSC, 50 people will chime in. But if the post is about billions in fraud or outrageous healthcare costs. It does not get much interest.

Healthcare...leading cause of personal bankrupcy in USA, 100,000 deaths by mistake per year, main cause for our national deficit, .......and not much interest by most people.

Thanks for your thoughtful comments. I am glad I am not the only one concerned and watching this.

Amen Bret. Well said.

I wonder what the hospitals will do now that they cant complain that someone doesnt have insurance, and claim they have to charge what they charge. As for the vials of medication, maybe they should buy them and sell them to the hospital...they could make a little profit. It really makes a person think when you hear about things like that.

I agree with you. I suppose most are lucky that they havent been personally affected by a medical scam, but most other things you mentioned hit a lot of people so they vent here, and most of us are in the same boat. It is so odd that you hear outrageous stories of fraud and then it just disappears as easily as it appeared. Im sure there is alot more that goes on that a person doesnt know about...thats the scary part.

(quoted from post at 14:37:03 01/29/14) Funny, but I sort of see the discussions on YT Mag as a reflection of the way Americans think.

If someone posts about Propane prices, or Diesel fuel cost increases, the price of parts at the JD dealer, or the price of rake teeth at TSC, 50 people will chime in. But if the post is about billions in fraud or outrageous healthcare costs. It does not get much interest.

Healthcare...leading cause of personal bankrupcy in USA, 100,000 deaths by mistake per year, main cause for our national deficit, .......and not much interest by most people.

Thanks for your thoughtful comments. I am glad I am not the only one concerned and watching this.

Click to expand...

Edd, I think the parts cost, propane cost, and dare I say it...ethanol discussions get a lot of response because the people here are closely affected by those issues.
We're all affected by healthcare costs as well, but in recent years it's almost impossible to talk about healthcare costs and fraud in the healthcare system without getting into politics which is a no no on this forum.
I think many on this forum, especially those of us from Illinois are so used to hearing about fraud in government and government programs that we've become desensitized to the subject. It's also difficult for some to talk about government fraud or fraud in government programs without getting political. You may not realize it,your original post had political overtones...[i:defee9f079]"2008, before AHA?[/i:defee9f079]" With the people in this country so divided over political ideology all it takes is seeing "2008" to think of "W", or "AHA" (actually ACA) to think of "external_linkcare". At that point the lines are drawn and the discussion will become political.
I happen to agree with your original post. The fraud is bad enough but to think of what the victims and their families went through unnecessarily is down right appalling.
We need to crack down on those that commit fraud. Someone should being doing jail time for performing unnecessary surgeries.
As far as controlling healthcare costs. That will be very tough to do without cutting healthcare service to someone, or without some severe limits on malpractice awards. Also cutting costs could slow development of new medicines and medical procedures. Try to have a discussion about how to do that without becoming political. I don't see that happening.

There is fraud in just about every 3rd payer situation. Car insurance, unemployment insurance, homeowner insurance, taxes, home improvement scams, etc.

If some institution is giving money to someone for something, there will be someone who will abuse the system. Can't just blame the health care industry.

Lots of complaints on here about doctors/hospitals and unnecessary tests, bad diagnoses, etc. Everyone expects health care to be PERFECT, they expect ALL doctors to be the same in terms of intelligence, medical knowledge, diagnostic capability, etc. Guess what? Nothing is perfect. But ....look at the life statistics and we're doing much better than 100 yrs or even 50 yrs ago. Most of us older guys (60+) would be dead by now if we lived in the early 1900's.

At the first hint of an imperfect outcome by a healthcare professional, the first call is to a lawyer. My brother is a Hospital Risk Manager and its sickening the stories I hear of people who won't take care of themselves (obese, diabetics on poor diets), won't listen to doctors advice and when they die, the family sues the health care provider. It's the health care LOTTO.

So, before everyone throws the entire health care industry under the bus, check your medicine cabinet and the meds you're on that are probably helping you stay alive.

There are "for profit" and "non-profit" hospitals. The non-profits are required to provide service regardless of the ability to pay - insurance or not - and have signs posted stating that.

Hospitals are becoming "resort/hotel" oriented with water-walls, fancy cafes, expensive artworks,"healing gardens" and host of other crap that have nothing to do with healthcare. I have a concern seeing carpet rather than tile floors that make it more obvious that they are being cleaned.

HEY! I'm going in for heart surgery on the 11th to have an ICD put in to regulate my poor old wornout heart. So don't be scaring me with all this fraud and stuff. Please
Walt

No doubt that there have been major advances in medicine over the last 50 years and all of us old geezers can thank the advances for making our life better.

Both my grandfathers died 30 years ago, ages 92 and 94, before cat-scans, MRI's, ultrasounds, Dopler tests, and routine stint surgery. So, I might not be so quick to agree that we would all be dead by now without modern advances.

However, your point that the malpractice lawsuit business hurts healthcare costs is a good one. I see more ads for ambulance chasing lawyers than for peanut butter or used cars. It is now an American industry.

Fixing healthcare costs is like reducing your heating bills. It is not just one item it is doing all the right things. Seal the windows, add insulation, get a more efficient furnace, turn down the thermostat, wear a sweater.

So, lets cut out the fraud and scams, make frivolous lawsuits more difficult and painful,
incentivize healthier lifestyles, crack down on pointless get-rich-quick tests, etc etc etc.

It took us 50 years to get in this mess,and we won't get it fixed overnight, but we won't get far at all with both sides just lining up like kids on a playground, and calling each other names.

There are two reasons for the often unnecessary tests. Profit is one, and liability is the other. Until the malpractice awards are limited in some way, the healthcare industry will continue with the CYA mentality and perform unnecessary tests.
The system is a complicated mess.
A family member had a health problem. The family member's supervisor who has a background in nursing knew right off what the problem was. She reported what she had observed to the family member's doctor. Dr. ran some tests. Sent the person to a specialist who ran more (very expensive) tests. Then it was back to the primary, then off to another specialist and more very costly tests. It was close to 5 months before they actually started treating the problem because they had to run all of those tests, most of which were unnecessary. If they had tested for what the supervisor had suggested right off the cost would have been a fraction of what it was, and the family member would have gotten some relief from the problem months sooner.
As for your g-pa/s living so long. Your family must have good genes. My g-pa's died at 56 and 71.

(quoted from post at 08:58:22 01/29/14) There is fraud in just about every 3rd payer situation. Car insurance, unemployment insurance, homeowner insurance, taxes, home improvement scams, etc.

If some institution is giving money to someone for something, there will be someone who will abuse the system. Can't just blame the health care industry.

Lots of complaints on here about doctors/hospitals and unnecessary tests, bad diagnoses, etc. Everyone expects health care to be PERFECT, they expect ALL doctors to be the same in terms of intelligence, medical knowledge, diagnostic capability, etc. Guess what? Nothing is perfect. But ....look at the life statistics and we're doing much better than 100 yrs or even 50 yrs ago. Most of us older guys (60+) would be dead by now if we lived in the early 1900's.

At the first hint of an imperfect outcome by a healthcare professional, the first call is to a lawyer. My brother is a Hospital Risk Manager and its sickening the stories I hear of people who won't take care of themselves (obese, diabetics on poor diets), won't listen to doctors advice and when they die, the family sues the health care provider. It's the health care LOTTO.

So, before everyone throws the entire health care industry under the bus, check your medicine cabinet and the meds you're on that are probably helping you stay alive.

Click to expand...

I'll tell you this friend, I was a cop for over 20 years. If the medical industry was held to the same standards we were, there'd be a huge change in things. People demand near perfection from everyone from cops and auto repair workers to builders and bus drivers. Why not the medical industry? I don't mean bogus law suits where someones planned 38 DD's are only D's and point in different directions, I mean taking doctors to task for playing god and ruining peoples lives. It's criminal.

(quoted from post at 08:31:57 01/30/14)
I'll tell you this friend, I was a cop for over 20 years. If the medical industry was held to the same standards we were, there'd be a huge change in things. People demand near perfection from everyone from cops and auto repair workers to builders and bus drivers. Why not the medical industry? I don't mean bogus law suits where someones planned 38 DD's are only D's and point in different directions, I mean taking doctors to task for playing god and ruining peoples lives. It's criminal.

Click to expand...

Very simplistic view. The devil is in the details and health care is a very complicated profession: Go to a doctor with a symptom like "feeling tired all the time". This could be anything from "normal" to cancer to whatever. Doctor will run some tests and get the results back. They have to request specific tests and each one costs money. Ever look at the results of lab tests? Certain #'s may be "borderline". Others will be elevated and the doctor will make an educated guess based on what the results may be. They'll try something and wait to see what effect it will have. This is complicated by the fact that not all treatments work the same for all people. I am not a doctor but my daughter has been through years of treatment for severe organ disease, has developed an auto-immune hepatitis that is under treatment now. No miracle cures there and we all recognize the ups and downs of health. My wife works for a world renowned specialist in Infectious Diseases and sees patients from all over the country who come to him after all else has failed. He is not a "god" but he's world renowned in his field for a reason: he's darn good. Sometimes his diagnoses and treatments help, sometimes they don't but patients expect "perfect outcomes" from him and get upset when he tells them there's nothing more HE can do. And people take doctors "to task", not for playing God, but because they don't get that "perfect outcome". Your comment is silly that the health care industry is not held to the same standard as other professions. It is highly regulated, licensed and under a microscope, more so than any other profession. Sure there are bad doctors. There are also bad cops that abuse their power and "play God".