Hospital to Rehab – The Great Medicare Scam

 

 

You have phones in hospitals — don’t be afraid to use them.

This is one of my all time favorites — the “Hospital to Rehab” scam. Here’s how it works:

A medicare, assisted living center client needs to go to the hospital . . . usually dehydration, a urinary tract infection or some “non-death” reason. The person is transported to a hospital ER and the battery of tests begins. (For purposes of this hypothetical it’s the second time the patient has come to the ER because to get paid the hospital MUST admit them.)

The elderly patient becomes totally disoriented (happens 90% of the time in the over 80 crowd — only 80% in the over 75 crowd!). Think about it, strangers come in at all hours of the day and night, sticking needles in your arm, taking blood pressure and sleep is constantly interrupted. Time is indistinguishable. Once again, the elderly have no control and in many cases become combative because they don’t want to be there and no one explains what is going on. Medication is given to calm them down — the heavy sedative. Usually security is in the room to assist. Imagine how it must feel to be held down and given a shot. It gets better — the patient becomes woozier — powerful sedatives plus loss of control . . .

Next step, an alarm is added in case you get out of bed (like to go to the bathroom) so this very loud noise adds to the alarm and loss of control. Bottom line, you end up laying in bed, woozy, scared and not understanding who you are or where you are. Then — boom — the diagnosis, a UTI! OK, one day of treatment (antibiotics) and you can go home! NOT SO FAST! You’re weak, you need physical therapy, the drugs are not through your body . . . a myriad of excuses as to why you must go to rehab.

[An aside here, once the insurance company approves physical therapy they will pay for ALOT of sessions. Hence, these rehab centers love physical therapy patients. Most of them are also medicaid nursing homes.]

Oops — Bad news —- you can be discharged on Saturday but the rehab doesn’t take transfers on the week-end because they don’t pay people to do the paperwork on Saturday and Sunday. Now we offer to pay for a private physical therapist to come to the assisted living center and work with the patient in his/her home. Nope — can’t do that either because the hospital will only discharge you Against Medical Advice (AMA). Medicare doesn’t’ pay AMA claims.

Bottom line, the elderly patient has to stay in the hospital for two extra unnecessary days before rehab will admit him. There is a five day minimum and now a UTI is a 13 day hospital stay! Who wouldn’t be stark raving mad!?!