Suspicion of Medicare/Medicaid Fraud (part I)


Last week my electric wheelchair lost power while I was out wheeling in the neighborhood and I had to deal with the police, ambulance company, medical transport and the bus company in order to get home.  I thought the power outage was a fluke but three days ago it happened again.

            The chair was purchased by Medicare/Medicaid at a cost of about $8000.  What that means is that I cannot call the supplier and request repair.  I have to call my doctor and get him to write a prescription for wheelchair repair.

            You’re kidding me, right?!

            Nope.  A wheelchair problem has to be run through the primary care physician.  He didn’t go to medical school for this, nevertheless, physicians have accepted the job of gatekeeper to services, which is ridiculous but maybe feeds their egos.  Why don’t they just refuse to do it?  Place authorization of eligibility for services with the product supplier, not the physician. 

            Well, okay, the system is what it is so bright and early Monday morning I call the doctor’s office and ask for a script for wheelchair repair.

            And they refuse to issue it.

            Because I haven’t been seen by the doctor in over six months!

            But I’m not sick, I say; my wheelchair is.

            The girl on the phone argues with me but we finally agree that she will email the doctor and see what he says.  By 4:30 p.m., I haven’t gotten any return call so I call again and make a first-available appointment for Thursday, which means I have to cancel my trip to the farmer’s market to buy the fresh fruits and veggies that keep me healthy.  Instead, I will go sit in a doctor’s waiting room, surrounded by sick people, for an appointment I don’t need.

            Tuesday morning I tell my case manager about the problem, and she calls the doctor’s office.  She gets a different girl, and her girl agrees to have a script faxed to the supplier.

            Later in the afternoon another girl calls from the doctor’s office to say that she’s faxed the script to the supplier.  “Oh, good,” I say, “then you can cancel my appointment for Thursday.”

            “No,” she says, “we faxed the script because you have an appointment.”  Now I start to get mad.  I try to talk to her.  I tell her that I don’t need to be seen, and that Medicaid wheelchair transportation to get to the appointment will cost the taxpayers more than $50, and the doctor’s bill to Medicare will be somewhere north of $60.  Why should the taxpayers be charged more than $100 for an appointment I don’t need?

            Besides, I say, when I come he doesn’t see me.  I sit in the waiting room for about an hour and then go across the hall to Urgent Care.

            I know, says the girl.  Then she reads aloud from her computer and tells me exactly what I’ve been doing.

            About a year ago I had my first appointment with the doctor.  It was for a physical.  I receive care from home health aides.  The aides are paid by Medicaid and authorized by the Long Term Care Unit of the Resource Center of the Community Service Division of the Dept. of Social Services of Onondaga County.

            I’m not kidding you.

            So the county decided we all should have annual physicals in order to continue our aide service, which is stupid.  If you are so wrecked that you are getting aide service, then you are seeing about half a dozen different doctors at the rate of about one every three weeks.  Go have a physical?  Like, what, you think the doctor hasn’t noticed I’m sick?  If you want the doctor to fill out a continued-need authorization once a year, that’s fine but for Pete’s sake don’t waste our time and your money on annual physicals for people who are chronically ill.

            So I went to the doctor for a physical, waited a long time for him to show up, and that was that.  The next time I wanted to see the doctor was because I’d hurt my finger.  I waited fifty minutes but the doctor didn’t show up so I went across the hall to Urgent Care, where I went through triage, admitting, diagnosis, treatment and discharge in 45 minutes.  Two other times I tried to see Dr. Feldman, waited too long and went to Urgent Care again.  Urgent Care is friendly, fast and good, but they don’t do routine physicals or wheelchair fixes.

            So now the girl on the phone tells me I have to come in every three months to see the doctor!

            Why, I howl?!

            So he can follow you, she says, follow your diabetes and things.

            I try to explain to her that there’s nothing to follow because I’m not taking any drugs (i.e., medications).  I have a weird problem in that my immune system is hyperactive.  If I take a drug it very quickly makes me sicker than the illness I was taking it for, so I can’t take drugs.  If you are taking medications on a regular basis then there may—may—be some justification for frequent follow-ups but I’m not so there isn’t.

            If you are not receiving treatment, then there is nothing to follow up about, and if you are being “followed” then you should be seen, not left sitting in the waiting room.

            The girl is adamant that I have to come in every three months, and I realize that it is useless to argue with her:  she doesn’t make policy.  I ask her who does and she tells me to call back and ask for the floor manager.  WTF?!  Since when does the medical industry have floor managers?  Grocery stores have floor managers, not doctors!  I ask her the name of the floor manager and she says, “Oh, there are several.”

            So at zero-dark-thirty this morning I woke up and got on the computer.  I am, by God, going to write such a letter to a managing partner in this practice!  Doctors should keep their appointments on time and patients shouldn’t have to make appointments if they’re not sick.  And wheelchair repair scripts should be faxed without seeing the patient.  (To be continued)

About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
This entry was posted in Fraud, Government Services, Health Care, power wheelchairs, Values and tagged , , , , , , , , , , . Bookmark the permalink.

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