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Medical fraud: The cost can be more than money

Medical fraud is one of the most damaging, dangerous, and economically prevalent frauds affecting everyone.

You may indeed have Marcus Welby as your doctor, however, part of any medical practice is referrals and Welby does not accompany you. You also travel, could be unexpectedly hospitalized, or might require specialized or unexpected care. None of us can simply STOP getting medical care, but we can become very careful and take control of our own — and our loved ones’ — circumstances.

Depending upon whose estimate you believe, annual healthcare fraud costs exceed $100 billion. Adding the words waste and abuse, the number triples. Remember, too, that published numbers are based on what we catch, not what makes it through the system without detection!

Protecting Yourself

1. Take control of your medical records: Read your chart notes and discuss needed corrections before you leave the doctor’s office. Once you walk out the door, anything written in your chart becomes Gospel. (Personal example: Imagine my surprise to learn that my records reflected a surgical procedure I never had!)

2. Review your insurance coverage and understand what you are entitled to. (Personal example: I found I could get a second opinion AND a third opinion.)

3. Vigilantly review billing copies you receive. (Personal example: A hospital billing included an IV infusion that I never received.)

4. Be aware of who is entering things into your chart. Doctors trust many duties to assistants and anybody can make a mistake. (Personal example: A nursing assistant took my blood pressure — she took it from the right arm, did not support the arm or raise it to heart height — and recorded a very high reading.)

5. Know your own body. (Personal example: A physician took a blood sample from just below an IV that was giving me a glucose solution. The results of that “test”, duh, revealed a sugar count of over 400. Thankfully I knew enough to refuse immediate intervention — which could have killed me or rendered me brain dead — and demanded a repeat.)

6. Keep copies of ALL medical records because doctors only keep them for seven years. (Personal example: An anomaly was spotted on a current MRI. A previous MRI — in my possession from 10 years earlier — showed the same anomaly. Identical placement and size. Without the backup MRI, I would have found myself full of needles, procedures and unnecessary additional investigation.)

7. DO NOT participate in “free” offers of care from telemarketers. Clinics offering free care are generally going to find something that they can charge for. It’s business.

8. Watch those co-pays. It’s not unusual for a non-covered service to be sneaked in and the patient must pay as a co-pay. (Personal Example: A eye exam 100 percent covered by my insurance cost me $30 to get the written prescription for eyeglasses. Had I known, I could have simply requested a copy of my file and that would have included the prescription form.)

9. Never give out your personal information or Medicare number in order to receive FREE information. Medical identity theft is big business.

Drop by the Pahrump Valley Times offices, 2160 E. Calvada Blvd., for a copy of Leslie Kim’s latest book “123 Main Street … the Scamming of America.” Only $19.95 while supplies last.

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