Hospital had to repay over a million to Medicare...kept frail seniors overnight for spinal procedure

madfloridian

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Wed Jan-05-11 11:47 PM
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Hospital had to repay over a million to Medicare...kept frail seniors overnight for spinal procedure

So this is considered Medicare overbilling? And the hospital finds it cheaper to pay it back than to try to prove that many of the seniors needed the overnight stay?

This is ridiculous. To send some seniors home the same day after a spinal procedure is dangerous.

This is why I got so very angry that a man the president picked to lead the way on Social Security and Medicare called seniors "the greediest generation".

LRMC to Pay $1,660,134 In Medicare Overbilling Dispute

Lakeland Regional Medical Center and six other hospitals in six states are paying more than $6.3 million to settle federal allegations they overbilled Medicare for kyphoplasty procedures done to treat some spinal fractures.

..."LRMC's payment is $1,660,134, which Bob �Puterbaugh, LRMC's lawyer, said is an amount 2.25 times the difference between the cost of doing those procedures on an outpatient basis and admitting the patients for one night as inpatients.

That's the crux of the dispute that led to the settlement announced Tuesday: The government contends LRMC and other hospitals performed the procedures on an inpatient basis to increase their Medicare billings when some could have been done as outpatient surgeries.

The lawyer gave some examples of those who were kept overnight. Very frail senior citizens with multiple problems. The greediest generation??

Puterbaugh shared examples, with names removed, of patients who had gotten the treatment and their multiple, coexisting health conditions. One patient who had the procedure was 94, living alone, and had degenerative arthritis, osteoporosis and previous colon cancer and had recently fallen.

A 75-year-old was a diabetic on insulin, had heart disease, previous cardiac arrest after surgery, previous ministrokes, osteoporosis and breast cancer that had spread. That patient was considered at risk of falls.

In November two federal courts ruled that the Obama administration was using standards for Medicare that were too strict. That was with a Democratic congress and Democratic president. That truly offends me.

Those courts referred to skilled nursing home care and home health care.

Medicare Standards Too Strict, 2 Courts Find

WASHINGTON | Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care.

..."The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis, Alzheimer's disease and broken hips. Skilled care may be reasonable and necessary and covered by Medicare even if the person's condition is stable and unlikely to improve, the courts said.

The government has not said whether it intends to appeal either decision.

Rep. Joe Courtney, D-Conn., welcomed the decisions. "People with chronic conditions are being denied care in the mistaken belief that Medicare requires improvement of a person's condition as a prerequisite for coverage," Courtney said Monday. "That's not in the law. It's urban legend."

I have learned that many younger people think Medicare comes without cost. It does not. Monthly Medicare payments are taken out of Social Security payments, and most pay in addition for Medicare Advantage or prescription drug care. I have seen 0 co-pay plans advertised, but they deny many services.

Keeping an elderly at-risk person overnight for any procedure should be the decision of the doctor, not Medicare officials sitting in their offices...not insurance companies handling Advantage plans.