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.  
 


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I appreciate the people who operate lawfully to receive referrals.If the patients chose not to use those companies the administrator conducted a witch hunt.

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