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Archive for December, 2009

Real stories from real patients: A scary night in the ER

Thursday, December 31st, 2009

A new addition is being added to the blog. Our healthcare system is broken and fragmented and patients are usually the ones that receive the brunt of the abuse. Real stories from real patients will highlight the traumatic events that patients have to face in the wake of terminal illness, an accident or any other medical emergency.

Names have been changed to protect the innocent.

A scary night in the ER

“I have been watching my friend for the last 24 hours. First in the ER being monitored by a machine for his heart, oxygen and blood pressure – the alarm is turned off so it doesn’t make any noise – followed by a 6 hour wait for EMERGENCY surgery – hoping that he gets in the cue prior to the onset of internal rupture. I watched patient transport almost pull him out of the room without disconnecting the tubes from the wall – a frustrating reminder that the focus on reform is not about health.

After surgery I was watching him recover and yet again the $200 monitor has the alarm turned off. I thought to myself, ‘I wonder what would happen is there was no one in the room and he couldn’t call out for help?’

My friend received a 2mg narcotic through his IV around 6:00 pm. At 8:00 pm the nurse came back to evaluate for another .5mg of the narcotic. I watched his nurse place the injection on the table, take and enter vital signs into the bedside PC and while I was looking at my notes, the nurse left the room. I asked my friend, “Did the nurse give you anything?” He didn’t know. I looked for injection marks on his right arm – nothing. I walked out and asked the nurse, “Did you give him the injection?” The nurse’s response, “You were in the room the whole time, did you not see me give it to him?”

I took a step back – I am tired and need to turn off my fraud, waste and abuse examiner’s hat. However, I wonder on these points…

1. I believe the nurse stole the narcotic and did not give it to the patient. The next day the floor nurse let me look at the medical record. The patient received the narcotic at 8:00 pm IVP – which means the nurse would have had to ask me to move since I was sitting next to the arm with the IV.

2. The on call surgeon had to wait until the on call surgical staff finished operating on the patient’s rupture appendicitis. He was ready for surgery at 10:00 pm but could not get in until 1:00 am. So what would have happened if the bowel obstruction ruptured any time before 1:00 am? Would he have died in the ER? Been transferred to another hospital?

3. What would have happened on the snowy icy night if an auto accident had been admitted? Would he have been bumped? Did the hospital put their ER in bypass mode?

4. Now what about the ER nurse, did he take the narcotic himself? Was he feeling a little ‘happy’?

False Claims Act and Healthcare Fraud Reporting

Thursday, December 24th, 2009

The False Claims Act was passed by Congress in 1863 and allows people who are not affiliated with the government (Congressmen, the President etc.) to file actions against federal contractors claiming fraud against the government.

In our current economic forecast with fraud running rampant (the Madoff scandal, the collapse of the financial market etc.) the False Claims Act is still relevant. Even with the abundance of accounting fraud, the major focus of the False Claims Act is still healthcare fraud. According to an article in the American Medical News, “Healthcare cases made up the lion’s share of false claims settlements and judgments in the fiscal year, brining in $1.6 billion, or two-thirds of the total $2.4 billion recouped.

Read full article here.

Healthcare fraud is a huge industry for the ethically challenged in our country. Keep reporting – it is a great deterrent.