Mrs. Smith was an elderly woman with dementia whose husband was her
caregiver.  Both of them were admitted to a nursing home after her husband broke his hip.  They shared a room, with Medicare paying $700 + per
day for his care while their family paid about $200 per day for her room &
board.  This way, they could stay together.  
    The nursing home administrator had another idea; she directed me to
complete the paperwork that would send Mrs. Smith to the hospital against her will on a 72-hour hold because she was a danger to herself due to her Dementia.  If Mrs. Smith remained there for three days, she could return to the nursing home and they could bill Medicare for all sorts of treatments she didn’t need.  
   This was a blatant manipulation in order to game the system. 
Mrs. Smith wasn’t experiencing a mental breakdown and it wasn’t appropriate to send her to a psych ward; the hospital never should have accepted her.  I should mention that the nursing home administrator had bragged on several occasions that the local psychiatric ward would accept any patient she sent and hold them for at least three days – the magic number that allows the nursing home to bill Medicare when patients return.  
    After I refused to complete the forms that certified Mrs. Smith was a
danger to herself and to society, the administrator screamed at me for a few
minutes and then found a nurse who agreed to complete the paperwork (She later fired me).
  Mrs. Smith returned 3 days later and the nursing home billed Medicare at
the $700+ rate for the maximum amount of therapy for several months. 
Under the administrator’s direction, the nursing home then billed Medicare for three hours of therapy each day, even though she was so confused she wasn’t able to remember and benefit from the treatments.  
    The only benefit was to the nursing home and to the nursing home
administrator who received bonuses for behaviors such as this.

 


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