August 14, 2009 by roland.

Many many years ago, in my yoot, I worked for a peer review organization which did quality of care and cost analysis for Medicaid and Medicare. It was not for profit and came to a screeching hault during one of the constant funding problems the state had. I was a quality of care programmer writing all of the reports and indexed file entry programs to track quality of care issues from the review process. There were a fleet of nurses in the field looking over samples of patient folders looking for things that seemed odd. Those folders would find their way to the home office for physician review. Issues went from rank-1 (documentation) all the way up to rank-4 (gross and flagrant) where there was a high probability we would recommend the revoking of a license.

Occasionally we would get specific requests from Medicaid and Medicare to review billings that were out of the ordinary. Not that they tried to over charge the agency, but the same medical license was seeing patients in two different states on the same day.

There is one case I will never forget. Just such a request came in asking for a review of charts and invoices filed by a license number which appeared to be practicing in IL and … some extremely backwoods remote area of either Mississippi or Kentucky. It had been going on for about a year and they wanted a detailed investigation since our cursory transposition of digits check didn’t turn anything up.

I have never felt so bad for someone or seen such a miscarraige of justice. It turned out the doctor had been working in IL and shared office space with another doctor (whose license number he was now using). They did not share filing systems or clerical help. This particular doctor had hired clerical help that apparently had no concept of the alphabet or patient folders. There had never been a single quality of care complaint logged against him, but a year prior some random inspection of patient records found now two folders in the office actually contained records for only one patient. I don’t remember all of the details, just that his license got pulled as a result.

Usually, when a doctor gets a license pulled but keeps on practicing medicine it is greed or ego (usually both). Not this dude. He picked up and left an upscale suburb for a place that shows up on those “could it really exist in America” news clips you see during sweeps week. This time he apparently hired a clerk that could handle all of the filing and billing. Once again, not one single medical quality of care issue turned up. Had the billing not triggered a fraud sensor he would probably still be practicing today. He was the only doctor they had and pretty much everybody was either on some kind of government healthcare or seeking charity care.

I think of this story when the healthcare debate comes up. A doctor who had sh*tty office help got his license revoked. He tried to do penance by providing great care in a place which had no doctor. He still got prosecuted.

A 16yo kid, having no medical schooling what-so-ever, can sit at a desk in an office a deny you life saving emergency treatment. Neither they, nor the company that hired them can ever be sent to prison for practicing medicine without a license. On a basis of nothing more than quarterly profits, they have their own little built in Euthanasia board, but Wall Street calls them the Board of Directors.

Posted in Thankyou Sir May I have Another | Print | No Comments »

August 14, 2009 by roland.

I’ve been waiting to here one of the HMO funded fraud-masters utter these exact words in some town hall meeting on health care reform. Yes, major insurance companies, we are going to take away your corporate jets, your stock options, and your multi-million dollar executive salaries. Of course, if anyone had actually read my blog on the “Ethics in Income Act”, also known as “The 100 Fold Rule”, they would know how to take all of that away from you and fund a national healthcare plan.

Last night I turned on the new Jerry Springer Show, also known as CNN, and spent about 5 minutes listening to the talking heads rant on about death councils and euthanasia boards. It was all entertainment, no substance, which is pretty much what one expects from the Jerry Springer Show. There were wild and ludicrous claims that our healthcare would spiral downward nearly instantaneously to that of Cold War era communist Russia.

What they are trying to do, is establish a bottom. Right now we don’t have a bottom. You either pay for your own healthcare or you have none. Don’t toss up that argument about how Welfare recipients have state provided healthcare, that is simply another method of payment. You have to exist on welfare to qualify. Yes, we’ve all seen the welfare abuse reports and it is quite rampant. Anyone who lives near the Chicago area has also seen reports of what life is actually like in the public housing projects it once had. Don’t toss up the argument about employer provided healthcare. We pay for that healthcare by working for them and the amount of healthcare they provide continually degrades.

So, now we have a plan coming to the table which will provide a bottom. A government operated healthcare program people can “opt-in” on. Yes, there are hospitals and physicians that won’t accept Medicaid/Medicare today, but many do. My own parents have gotten old enough to be on Medicare. True, they also have a supplemental plan, but don’t think for one minute there won’t be a new rash of “supplemental” plans which use the government sponsored “opt-in” policy as their base. Hell, all they have to really do is change the rules for Medicare to allow anyone making less than $150,000 to “opt-in”. Those who don’t want it won’t bother signing up for it.

Quite simply I’m appalled at the juvenile fear tactics being spouted by the Republican party. It might shock you even more to find out I’m a Republican. That a tough thing to admit after two different and completely worthless Bush Presidents with an equally worthless Syphilis Willy Presidency sandwiched in between. Now we have so-called experts out there not just talking, but shouting out their ass the lamest ideas I’ve ever heard. Okay, next to W anything sounds intelligent, but come on!

Sadly, politicians have the greatest healthcare plan in the world. The only thing it lacks is the ability to force those covered by it to actually use it. Given the statements I’m hearing in the press, or reading about in blogs from actual prominent politicians, you’ve all got Dimentia and it damned well better get diagnosed soon!

Those of you too young to understand the title of this post should add the following movie to your DVD rental list:
http://en.wikipedia.org/wiki/Soylent_Green

Posted in Thankyou Sir May I have Another | Print | No Comments »