The common acceptance of the meaning of fraud is something for which someone goes to jail. Yet, it also can mean “tricky” stuff, or deception. If the result of the deception is just to make a person pay more for something than is necessary well, that’s “legal” fraud.
We are told that Medicare fraud is well documented and repeated daily around the country. This government run health care program has a current rate of fraud of thirty-four percent (34%). That percentage just covers the “Illegal” fraud. How about the “legal” fraud? How does it fit in?
The Obama healthcare law is some 2,700 pages long. Buried in those pages are words and phrases that are vague enough to support financial perks of unspecific dollar amounts to special interest groups who know how to manipulate them. The best way to illustrate that statement is to detail a simple event, and that is getting a wheelchair through Medicare. There is a business axiom that says “If one watches the pennies, the dollars will take care of themselves.” Keep that in mind.
Aside from special need wheelchairs, the typical wheelchair you see in everyday life is known in Medicare terminology as the K0001 – Standard Manual Wheelchair. The benchmark would be “What does it cost to purchase one outright with no reimbursement?” There are many that will meet the K0001 standard but here is one: The Everest & Jennings Traveler L#3 price is $212.97 with free shipping.
Now, let us walk through a real life experience recently reported to us by a CPartyUSA member.
The elderly, Medicare qualified patient was frail and a wheelchair was medically necessary on orders of a physician. The next day a medical appliance company called and said that they were coming out to deliver the wheelchair. The patient’s husband declined the delivery and told them he would come to pick it up because he wanted to be satisfied with the wheelchair. The next morning he found the chair was satisfactory. The clerk handling the transaction said that the Medicare co-pay was 20%. When the clerk wrote up the Credit Card ticket, the co-pay was for $250.
Here is the arithmetic on it: If $250 equals 20%, then 100% would be $1,250 total for it. No way!
At home, the spouse got on the Internet and found the same brand wheelchair, which he purchased, delivered within four days for less than $215. Medicare does not convey ownership to a wheelchair until after 13 months. The Internet purchased wheelchair was owned the minute of payment.
The conclusion reached is that it would have been all legal had the spouse gotten the wheelchair through the Medicare “system.” Later research found that within the “system” other vendors had co-pay prices of lesser amounts. But how was one to know? The “system” gives appearances that everything is all worked out for one’s benefit. Had the patient’s family, believing in that Medicare “system,” allowed it to flow unchecked, A to B to C, they would not have gotten the best financial outcome. It would be interesting to know the number of families needing a wheelchair for “Grandma” that are being walked through the Medicare Wheelchair “system” every day?
In sum, imagine what “legal” deceptive and tricky systems may result from 2,700 pages of Obama healthcare, if enacted? That possibility based on experience (wheelchairs) is sufficient to repeal it.
Sam Gallo
Chairman Emeritus, CP-USA
samgallo@cp-usa.org
www.conservativepartyusa.com
