Ever see how a home health care scam works?

[NNN0LHI]

All of a sudden one day at a meetings for the food bank my mother volunteers for someone wanted to give a presentation about the home health care available, which Medicare would pay for, that would allow them to have a doctor visit them in their own homes. And what a great deal it was. Then this young fellow who gave the presentation and identified himself as an employee of Medicare gave the food bank a check in appreciation for listening to his spiel. That impressed my mother right there. She is from the Great Depression era and still thinks in her mind that a hundred dollars is very close to a million. She is still talking about that hundred bucks to this day.

After this fellow finished up the old folks began talking about what they had just heard and there were obviously a couple of ringers who worked at the food bank and who were at the meeting who said they had already signed up with this company and were swearing it was the best thing since sliced bread.

All my mother wanted to know was would the doctor, or whomever, came to the house dust her blinds? And when one of the ringers told her sure they will do anything you want them to do, she was sold. She needed these home care visits that everyone else was going to get and she wasn't going to let them get something she had coming to her and not get hers. She had no idea and didn't care what Medicare was going to be charged. She never even asked the price. It was immaterial. She just wanted what was coming to her.

These people who are promoting this to the elderly know the psychology of how many elderly people think too. It is like my mother is in competition with everyone she knows over who can get the most for free.

If some person is going to get someone coming into their house to clean the place for free, my mother is going to get it too. Simple as that. End of story.

So, she did sign up and after a few visits by a few people to check her vital signs and give her a quick once over then they left. Same thing her doctor does every month. No one dusted her blinds. No one sat with her and watched Judge Judy. So she finally canceled the services. She didn't want to be tied down waiting for people to come to the house. She likes spending time at the gambling boats and she is not going to let someone checking her vital signs interfere with that. But she still passes that guys card out to everyone she meets. That hundred dollar donation, you know?

So there it is. I am sure there are a lot of people who deserve and need home health care. And they should get it for free. But why would someone even be offering services designed for the home bound at a meeting where all the people there are mobile enough to volunteer at a food bank several times a week?

Understand, whats going on here now? The Obama administration is trying to put a stop to these types of scams designed to make a few people really rich. See why they are complaining?

If I was in that business I wouldn't like President Obama either. He would be on my shit list.

Don

Here is the company that pulled this with my mother: http://www.evercarehealthplans.com/

[hedgehog]

1. Kick!

I have in-laws who are against any kind of government spending. Their town has a free weekly senior's luncheon. Guess who's down there every week to get their free meal? I'm not sure how the program is paid for, whether it's state, local or federal or some combination. But I'm sure my in-laws spend some of their meals shaking their heads over how high taxes are because of the welfare freeloaders in the city!

Mind you - I think it's a great program. I just wish people realized that government works for them!

[FSogol]

2. K & R. n/t

[sinkingfeeling]

3. Hope Obama's plans include the 'scooter' scams as well.

[glowing]

9. Actually, they are. They are now making the scooter program into a "rental"

agreement. As long as the person needing the scooter is using it, the scooter is rented for the person my medicare.. There is no more "free" scooters that end up on Craigslist to be sold because Grandma died or recovered and doesn't need it anymore so the Grandson sticks it on craigslist or e-bay for some extra cash... Which is what my husband did with his Grandmother's scooter. The woman never used it ever, my husband gave her $200.00 and sold it for $600.00 all off of the Govt's dime (taxpayer's dime)... However, the scooter did go to a gentleman who was under the age of 65 and in bad health. He needed a scooter. He did not qualify for a "free" scooter because of his age. So, he basically got a free scooter for 1/3 of the price if he had to buy it from a scooter company on his own. It would have been cheaper for the govt to directly help the actual man in need.... And because we were selling it, a gentleman who was interested in buying it (not the man who ended up buying it) told my husband that medicare wasn't allowing them to be purchased anymore. They would only pay towards the rental of it. I'm not sure if they would still buy it for a person who actually would need to use it the rest of their lives, but for someone who needs it for rehab purposes, its definitely a rental program now.

[Demeter]

4. I contract with the elderly in my town to do Light Housekeeping under FIA

a state program.

Dusting, vacuuming, laundry, driving, shopping, dishes, that kind of thing. I don't do anything involving personal care beyond cutting fingernails or combing hair.

Other workers with the same agency have medical training of some sort and can do simple medical tasks as well as the housework, including bed baths, lifting and transport, etc.

[NNN0LHI]

8. We also have similar programs here in Illinois for those who qualify

And I don't think one person at this meeting would have qualified for it.

They all drive and lead active lives.

Don

[Lasher]

5. He shouldn't have identified himself as an employee of Medicare.

He isn't, and portraying himself that way is a fraud that should be punished by jail time. I once met a Medicare Advantage sales representative who what at my in-laws' house. I needed a crowbar to get her to admit that she wasn't a Medicare representative.

Me: OK when you get your paycheck, does it say 'US Government' on it, or does your check come from someone else?

Her: It comes from someone else.

Me: Aha. And from whom does it come?

Her: It comes from Health Insurance Company X.

Me: So you are not a Medicare representative. You are a representative of Health Insurance Company X.

Her: Well I work for Medicare.

Me: No you don't.

I am paraphrasing, but this is pretty close to what went down.

[NNN0LHI]

6. I had pretty much the same conversation with my mother about this

She would have none of it. Give her a lie detector test and ask her if that flim-flam man works for Medicare and I bet she could say yes and pass with flying colors.

Nothing will change her mind. I gave up after a few month of trying.

Don

[MadHound]

7. Like any other service, you need to do your homework

My mother has a couple of conditions that would put her in a nursing home. But with home health care, she can live in her own home and her quality of life is greatly improved. We have home health care coming in four-five times a week for various things, including bathing assistance, general check ups, some light cleaning and physical therapy. At this stage in my mother's life, it is all about quality of life and home health care keeps her quality of life high.

Are there bad players out there, certainly. But if you do your homework and find a reputable outfit, home health care can be a blessing.

[Horse with no Name]

10. You are getting Home Health and Provider Services confused. They aren't interchangeable.

And they are very different in what they offer the patient.

The STIPULATION of receiving HOME HEALTH Services is that the patient is homebound--which means that if they are able to go to the doctor, then that is what they are supposed to do.

A doctor has to admit them for Home Health and certify that their condition makes them homebound. There HAS to be a skill or a qualifying illness. Home Health is different than provider services (which is what it sounds like your Mom was receiving). Provider services can be self-referred, then it is up to the agency to get them certified. The people that receive Provider Services aren't required to be homebound AND the person generally taking their vital signs is an unlicensed provider.

On admission to HOME HEALTH services, the patient must sign a certification that they understand that homebound status is a condition of services, and if they are not homebound, they become part of a fraud. I am pretty sure that your mom wouldn't have done this.

Obama wants to add $100 to HOME HEALTH visits...to the people that are legitimately ill, need services, and are generally on a fixed income. HOME HEALTH nurses do not clean your house either.

[NNN0LHI]

12. One of the people who came to her house identified himself as a doctor

A Russian doctor. My mother couldn't wait to tell her friends that she had a "Russian", doctor coming to her house. She was so excited.

Does that sound like a "provider services", program?

As far as signing stuff goes, she will sign anything someone puts in front of her if she thought they might give her a nickel for doing it. She doesn't read anything first. Elderly. Depression era.

Don

[Horse with no Name]

15. Yeah.

The agency (which sounds realllly flim-flam and should be shut down, btw) may have hired a Russian physician (which we do not recognize reciprocity--so he isn't a doctor here) as a front-man to convince the elderly of their legitimacy. This agency IS a scam operation, no doubt.

Which, because he isn't a licensed physician, also means that he wouldn't be able to order Home Health Services.

A lot of the weeding out of the fraudulent HH companies happened in the 90's, they are pretty rare these days because the fines are pretty significant and they have attached a lot of the responsibility for catching the fraud on the nurses...and I don't know many that would willingly allow a company to make millions defrauding Medicare and then end up in jail to make someone else rich.

There aren't ANY HH agencies where physicians make house calls. They simply do the referral and that is it. There isn't a need for it AND it isn't billable to Medicare. It is double services.

Nurses are required to attend annual training on fraud and given an 1-800 number to report it if they see it. Fines and prison time are attached for those that perpetrate it.

Provider services are set up for the elderly...most of the ones who are, like your mom, active, do not really want these services unless they are in need of them. I mean, what able-bodied person wants to have someone bathe them?

There is very little criteria other than age or disability that will preclude them from services...ranging from light housekeeping, running errands, bathing, cooking. etc. The providers will even take them to Doctor's appointments.

It is...one of the benefits of Medicare for the older ones who aren't sick but still need a little bit of help. However, the one you have listed has really crossed the line into fraud.

[sam11111]

14. Complexity, thy name is Corporate rulers. Much simpler in Finland

I have to laugh at the complexity of the above re.

[Uben]

11. There is so much fraud, they should rename it Mediscam

Like pharmacists or pharmaceutical companies that get people to accept having their meds mailed out monthly. When they no longer need the meds, they just cancel, right? No, they keep coming, month after month, as long as Medicare is paying, until someone actually contacts Medicare to notify them what's going on. It happens everyday in every city in the nation. Valuable drugs and Medicare dollars wasted so the pharmacists or pharmaceuticals can make some extra bucks. Billions in waste.

[Shagbark Hickory]

13. This is one of many scams but they don't have to cut funding to crack down on what qualifies. NT