Tuesday, November 15, 2016

Medicaid Fraud: The Real Culprits

For the second time in my life I find myself in the unenviable position of having to depend on the taxpayers to help with medical expenses. After working all my life, paying my taxes and having served my country honorably, I don't feel terribly bad about accepting help. I certainly am not one of the individuals that have used the system for generation after generation, like some. I became ill in 2014, my savings were depleted, I lost my home and found myself with enormous hospital bills. But let me back up a bit.

When I was in college, I found myself struggling to support a wife and four kids (the reason for attending college) and found it necessary to solicit aid from the state. I will say that after graduating I paid at least some of it back ( the people at DHS looked at me like I was crazy when I started bringing them checks). It was at this time that I began to notice that something was amiss. I realize that all of this evidence is anecdotal, but I can't believe that if this is happening to me, that it is an isolated case.

After breaking my back in a fall in 1985, it has become necessary for me to have occasional medical treatment. When seeing my primary care physician in the 90's I happened to see the computer screen at the billing window. Medicaid was being billed $1500 for an office visit that included one x-ray. Now I'm no expert, but I've paid out of pocket for both x-rays (which generally run between $75 & $125) as well as office visits that seldom run over $150. It was at this time that I began to suspect that the patients were not the ones running healthcare costs up.

More recently, at the tender age of 71, I find myself in need of frequent medical care which has caused me to witness a fairly troubling trend. Specialists. I am constantly being sent to a myriad of specialists, whether something is wrong or not. My philosophy about healthcare is fairly simple- if you're sick, you go to the doctor. To my way of thinking it is irresponsible to bill the taxpayers for seemingly endless tests for everything from sleep apnea (which I don't have) to hepatitis (which I also don't have). After a mild heart attack, my physician wanted me to see a cardiologist- understandable. After determining that my heart was OK he looked in my mouth for all of 5 seconds and determined that I suffer from sleep apnea that he insisted on treating. I insisted otherwise.

I was then sent to a liver expert for hepatitis (my liver enzymes were off on one doctor visit) He insisted I get additional insurance "just in case." I told him that I'd get back to him. I've noticed in the waiting rooms of doctors who specialize in Medicaid cases, that most of the patients seem to be poorly educated and likely to fall prey to scare tactics. This is how these unscrupulous doctors are able to bilk Medicaid out of billions of dollars. It's not the patients that are corrupt, they simply don't seem to know better. We're raised to trust the medical profession and if the doctor tells us that something is wrong, we tend to believe them. But, I guess I was born cynical. If I see something wrong, I'm going to say something. This is also to say that all doctors are involved. I go to a pain doctor who is wonderful. She puts the patients first and has never tried to suggest tests that are unnecessary.

Once again, I realize that all I have to go on here are my own experiences. But as I stated before- if it's happening to me, it's got to be happening to others. When you're spending other people's money there is no reason to be responsible. Personally, I feel a great debt to those who are footing the bill for my healthcare and if the doctors don't want to behave responsibly, I guess it's my duty to do it for them.

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