Saturday, September 24, 2011

Retirement Warnings - Why Our Health Care Is So High

In case you’re wondering why our health care is so high, here’s a news blurb that explains a lot of it. It’s from “What an Outrage” in September’s AARP Bulletin.

A podiatrist copped a Medicare fraud plea to the tune of $1 million plus. My first reaction was: Can a podiatrist have a business that big, even with fraud? Then I remembered that my mother visited one regularly to get her toenails clipped. I guess when we get up there in age, if we’re not religious about our stretching exercises, we can’t reach our feet to do this on our own. Note to self: Kudos for your diligence and keep it up.

The podiatrist accomplished his fraud using “Medicare Advantage,” a program offered through private insurers but regulated by the feds. The podiatrist operated in Maryland, practically under the fed’s nose. It gets better. During the time he submitted the tainted claims he was prohibited from participating in federal health care programs. That’s right. His name was on a banned providers list, yet his claims sailed through.

That’s not even my favorite part of this story. According to AARP, he actually billed for foot care on a double amputee. The outrage blurb quotes a professor from the Kennedy School of Government in what may be the colossal understatement of the year. “There are many faults within the system.” Ya think?

This story naturally spurred me to search for more Medicare fraud. While I didn’t turn up anything as outrageous as the footless foot care, there’s been a lot about Medicare fraud in the news recently.

Co-owners of a chain of mental health clinics ran a $205 million Medicare fraud scheme and have just been sentenced to 50 years in prison. They’re convicted of supplying bogus therapy services to thousands of elderly, including Alzheimer’s patients who couldn’t have benefitted from group therapy. I’ll bet they billed for services to some congressmen, too. You have to wonder how someone with no brain could be helped by mental health therapy.

Two weeks ago the feds charged 91 individuals in eight cities for participation in Medicare fraud schemes involving a quarter of a billion in false claims. The charges are based on a variety of schemes involving medical treatments and services, such as home healthcare, mental health services and durable medical equipment (DME.)

The latter is the most common area of Medicare fraud, via billing for equipment that was never delivered. DME includes wheelchairs, hospital beds and the mobility scooters you see in those goofy infomercials.

Certain people should not be allowed to have scooters. They never drove a car; they never even rode a bicycle. They’re dangerous just pushing a shopping cart around the grocery store. You can be sure many Medicare claims for scooters are for people who (in some cases mercifully) never got them.

Even Nebraska, home state of America’s favorite boy-next-door Johnny Carson, is not immune to scams. The state website reports that scammers pitch free health care supplies as a way to get Medicare numbers. If you suffer from back pain, you could be offered not just a free back brace, but a knee brace, too. Sign now and get braces for both knees! (If you need one for your third leg, you’re on your own.)

The Nebraska site also warns about giving out Medicare information to people at health fairs (or was that county fairs?) providing services like blood pressure reading, toenail clipping and diabetic shoes. Aha! My mother was right in step with the rest of Americana. I’m aware that PETA extremists eschew shoes made of leather. But what the heck are diabetic shoes? Made from the hide of cows on a sugar-free diet? And are there gluten-free shoes, too?

As a final test of the system, I decided to get a prescription for Viagra. It was filled without even a wink. Some of you are thinking: “What do you expect. We always knew you had brass ones.” Perhaps. But I’m missing the piece that does the heavy lifting, so to speak. (You know, that third leg that isn’t eligible for a Medicare-approved brace…)

And don’t tell me that Medicare thought they were approving female Viagra. Pfizer doesn’t produce it. Unofficial female Viagra is out there in an appropriate pink color, but don’t expect Medicare to pay for it.

I have a surefire idea for keeping costs down. First, find a foot care buddy, like you had for grade school fire drills. Second, pick out a nice bottle of wine. Once a week, get together and clip one another’s toenails. Then open the wine and admire your beautiful feet. (Remember: Clip first, wine after.) You won’t need a podiatrist and you sure won’t need therapy.

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