It is almost every day as a nurse patient advocate that I read a news item about the healthcare system that astounds me. It makes it clear to me that my role as an advocate for the vulnerable patient trying to navigate these unknown and complex waters of our healthcare system is so very important.
I recently read a press release about a California physician found guilty of a $12 million dollar Medicare fraud that involved upcoding Medicare claims and reusing contaminated catheters, this according to the Department of Justice.
Apparently, this physician recruited Medicare patients to his clinics and falsely misdiagnosed them with a venous insufficiency, which is when your leg veins don’t work well and blood can flow backwards causing blood to pool in your legs. This can involve pain, swelling, cramps, varicose veins and more. Additionally, he conducted medically unnecessary procedures on these patients and used inappropriate billing codes to obtain a higher reimbursement from Medicare to the tune of $12 million dollars. And if that wasn’t bad enough, he repackaged the used, contaminated catheters to reuse on future patients. These were catheters cleared by the FDA for single-use only!
How would a patient know this was going on? Patients tend to trust their physicians and not ask enough questions. Many times they don’t know the right questions to ask. Frequently, this is the only area of a person’s life that they are passive and act like a spectator. This story clearly shows that it is not safe to be a spectator in this current healthcare system.
Every day, we at Healthlink Advocates, are honored to assist patients understand what is going on with their health and what their options are as well as how to navigate the murky waters of the healthcare system. We know that we are making a difference in each of our client’s lives and health. We know what they don’t know and are skilled at asking the right questions, obtaining second opinions and checking the coding on the insurance bills so the likelihood of this fraud is minimized. When things get complicated with your health, don’t go it alone. You need a nurse and insurance advocate at your side to protect you.
Our ultimate goal is to educate and empower all of our clients to know their disease, illness, options and exactly what their insurance covers and how to review all of the bills in-depth. We feel by advocating this way we can slowly change the healthcare system one client at a time.