The links on the front page today are all about Private Guardianship in Nevada.  The laws in Nevada are pretty lax - and I've heard that they're much the same in other states.  This opens the door to abuses such as those discussed in the links.  The courts require that Guardians submit annual accountings of how monies were spent - but they don't enforce this rule.  Nor do the courts question the charges, which are supposed to be reasonable.  

Essentially, all it takes in Nevada to become a Guardian is to pass a test and be able to show up in court.  One of the links (Ripoff Reports) discusses the hearing master flirting with a Private Guardian and totally ignoring the objections of the Ward's family.  And it gets better: one of the court-appointed Guardians actually charged his Ward thousands of dollars to read the complaints on the Ripoff Reports website.  He threw all of his business to one law firm and paid them extremely well for helping to strip people of their rights.  Not sure what the lawyer was doing the day in school that they discussed abuse, exploitation and 

The abuses have been ongoing for years, and only after a local newspaper wrote an investigative report did the courts even acknowledge there are problems with the system as it currently exists.  Hopefully this shit will be addressed and some real change will take place - and it's important to acknowledge that not all Private Guardians are worthless slime who view their Wards as little more than a mean ticket (in the most expensive of restaurants...).  I've met a few who are ethical, moral people who strive to help seniors and handicapped Wards have a better life.  

Read the links - all of them - and feel free to post some comments here.  I love  hearing what you h

Healthcare providers compete for your healthcare dollars.  Every large city - and even the smaller ones - have multiple providers.  Take home health care and hospice providers, for example.  It seems like anyone can open a company, and they'll receive most of the referrals from their medical directors.  If they'e small enough to be flying under the radar of the Medicare auditors and have little or no ethics, they can pay kickbacks to private companies (group homes, professional case managers) and they'll get even more patients.
     Home Health providers make their money by providing skilled care to patients who need it.  If they can get a doctor to prescribe the care, they can fake all of the documentation necessary to bill thousands of dollars for care they never provided.  Years ago, one of my patients told me that an occupational therapist would come to her house and eat lunch with her and call it therapy.  She was happy to have the company, and when she was told that this was fraud she was afraid she'd get in trouble so so she refused to report it.  I hear rumblings about kickbacks, where companies give cash for patients.  It's wrong, it's illegal, but with all of the budget cuts from the recession there's no one watching to ensure this doesn't happen.
     Kickbacks can be in cash, or in the area I'm most familiar with it's common for group homes to use the supplies the hospice provides for all of their patients.  This can save the group home thousands of dollars each year in the cost of supplies (briefs, underpads, gloves, etc).  This makes it more difficult 
for those providers who operate lawfully to receive referrals - even if they're serving a patient once he moves into a group home it's common for the operators to have the patients transfer to the hospice of their choice - the one that gives them the most money or supplies.
     Companies bad-mouth each other, complain about workers who won't cooperate with their tactics, and if they're caught they either sell out or shut their doors.  Not every company operates this way, but plenty of them do.  
     I worked for a nursing home where the administrator would only allow referrals to a couple of home health or hospice providers - and if the patients chose not to use those companies the administrator conducted a witch hunt.  My first week on the job she bragged about firing all of the housekeepers on one hallway because patients from that hall chose another provider when they left.  I lasted 4 months in that job before I was "suspended" for narc'ing on her to corporate and to the state - but if you believe that this isn't going on all across the country, you are sadly mistaken, my friend.  Fraud happens anywhere.
     You have a choice in healthcare providers; make your own decisions and don't allow anyone to force you into accepting care you don't want or need.  
You might notice a common theme with this week's links - fraud.  Whether it's Medicare Fraud, Medicaid Fraud, or Exploitation of the Elderly, it's everywhere.  Whatever happened to honesty and helping people?

One of the links refers to "over payments" one company billed over the past year to Medicare - $35 MILLION DOLLARS in over payments.  Many Nursing Homes don't employ their own therapists, they contract with professional rehabilitation companies, which is the business model for RehabCare. Since Medicare pays close to $1,000 per day for a senior to receive the maximum amount of therapy possible for a nursing home patient, is the goal to perform as much therapy as possible or to help as many patients as possible?  

I've been present when patients are goaded into receiving more therapy, being forced to stay longer in a nursing home than they wanted to, simply because the patient had "days" left (Medicare pays up to 100 days in a skilled nursing facility).  If a patient has payment left, they'll receive rehabilitation whether or not they want it (and even be threatened with a report to Elder Protective Services if they want to leave before the nursing home wants them to.   But if the patient is out of "days," the nursing home will dump them out as fast as they can.  I've also seen more than my share of dying patients being forced into therapy because Medicare doesn't pay for a patient to die in a nursing home, only to receive physical therapy.

The amount of therapy provided to a patient is at the sole discretion of the rehab company; the more minutes billed, the more Medicare pays.  The system is flawed, because the chances of Medicare identifying fraudulent billing practices are pretty slim - and $35 million dollars is a drop in the bucket compared to the hundreds of millions of dollars that Medicare pays for therapy.  It's better to keep on keeping on the way they have been.  

I've seen a lot of rehab in my day, and whether it's under the Part A or Part B programs, Medicare is paying a shitload of money for therapies that often don't make a bit of difference to the patients.  Rehabilitation can be helpful, but when a company can repay $35 mill and not bat an eye, there's something wrong.