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Home » Opinion

Medicaid Abuse From The Mind of a Paramedic

Submitted by on August 30, 2010 – 7:52 pm6 Comments
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By Jamey Perkins
It’s 5:30 am in a small city in northwest Indiana. Jerry, a veteran paramedic of 13 years, and his partner Karen are getting ready to leave the ambulance station for a run that will take them 4 to 5 hours to complete. Because their ambulance service is the only service in the city to offer paramedics, the city will be without a paramedic for coverage until they return. Until then, incoming emergency calls will be handled by only basic life support personnel. This leaves the critically ill or injured to have to wait until arrival at a hospital to receive potentially live saving advanced care.
Arriving on the scene, they find a twenty something mother of 3 standing at the end of her driveway with her children. It isn’t that any of them have any physical need for an ambulance, they simply need transportation. Since they will not be home for a few hours, they all are carrying their packed breakfast. They are on their way to a doctor’s appointment for the middle child of the three, but since the mother cannot afford a sitter, the whole family must go. They all load up into the ambulance and take off for the long trip.

Does this story sound a bit ridiculous? It should, but the sad fact is that it is a true story. Every single day, thousands of people that do not require any type of emergency or even basic medical care use ambulances for transport. You may be asking yourself, “How do people afford to pay for these transports?” The simple answer is that in almost every instance, the “patients” carry Medicaid for payment.

Medicaid, sometimes referred to as “The Gold Card” by medical service professionals, was designed to help make sure that even those that cannot afford health insurance receive needed medical treatment. Though Medicaid is funded by a joint effort between state and federal programs, the costs are ultimately placed upon taxpayers.

What is a paramedic?

Paramedics are among the most highly tried emergency medical professionals, outside of a hospital. Their training is centered on providing treatment to critically ill and injured patients. Due to the amount of time and effort required to complete the paramedic program, they are also some of the most sought after emergency professionals. Most cities employ only a small number of paramedics in comparison to other levels of responders. In most cases, especially in small to medium sized cities, there will only be one paramedic on duty that is responsible for providing coverage to their contracted area.

The training required to become a paramedic is rigorous. Aside from classroom hours, paramedics are also required to volunteer long working hours at hospitals and on ambulances under the guidance of mentors or preceptors. Their training allows them to utilize advanced airway systems, provide cardiac monitoring, applying various pharmaceutical treatments, and performing advanced trauma care. They are masters at treating patients in any type of emergency situation, and are often called upon, even by skilled doctors, to use their skills to start difficult IVs or obtain compromised airways. Many medical professionals, such as nurses and doctors, will freely admit their admiration for a paramedic’s ability to perform such techniques in the back of a moving ambulance with such precision.

Although there are a great many “career” paramedics, many others are using their experience as a paramedic to help propel and guide them into advanced emergency and medical careers. Some go on to become doctors, while others move on to advanced careers in Emergency Management. Paramedics often proceed to become nurses, utilizing a paramedic to rn program.

So why do people so often use a paramedic ambulance as a taxi for non-emergent transports?

There is no simple answer as to why so many paramedic ambulances are used on non-emergent, or convalescent transports. If you ask a paramedic, he will probably tell you there are a few reasons.

  • Often times, the person requesting the transport cannot afford to drive themselves, or may not own their own transportation. It simply becomes too easy for them to pick up a telephone and schedule the ride.
  • Many ambulance providers see these types of transports as “guaranteed money.” Since Medicaid is funding the transport, the provider is guaranteed payment. That means the provider will rarely have to worry about using the legal system to obtain payment.
  • The system Medicaid has in place, allows providers to simply complete the needed paperwork, and then file the payment request online. Most times, this means that the request for payment and processing is made on the same day as the transport. Quite simply, it is fast, easy, and guaranteed money.
  • Many times, the people abusing the Medicaid system lack the sort of responsible decision making skills that prevent others from doing the same.
  • Medicaid continues to allow this type of abuse. Since it is considered a covered expense, many are more than willing to take full advantage of it.

The scenario described earlier in this article is not the only one of its kind. Each day, paramedics are called for emergency responses only to find patients openly abusing the system. While talking with Jerry, the paramedic noted at the beginning of this article, he began to tell me of other instances.

Jerry recalled a response recently where he was called out during the middle of the night for an unconscious male patient lying on a sidewalk. Upon arrival, jerry noted that the patient was a “frequent flyer”, a patient who calls often and sometimes daily for creative reasons. On this occasion, Jerry noted that his patient first complained of chest pain. After providing basic treatment, the patient refused more advanced care. Jerry loaded the patient in the ambulance and proceeded to transport him to the hospital.

After arriving at the hospital and turning the patient over to hospital staff, Jerry began to complete his documentation. Shortly after starting his documentation he noticed the patient was no longer in his hospital room. Upon inquiring with hospital staff, jerry found out that the patient had signed himself out of the hospital without any medical treatment given. It was then Jerry realized that the patient had a new address, and was now living across the street from the hospital. Jerry could only surmise that the patient had simply used the ambulance as a means of transporting him across town, so he could be closer to his home. Since then, the patient has made many more calls for similar reasons. All of the calls end in a similar fashion. It is now obvious to Jerry and his co-workers that this patient uses the ambulance service, and Medicaid, as a means to gain transport from one side of town to the other.

Why is this abuse of Medicaid allowed to continue?

Medicaid abuse occurs because current laws protect those who abuse it. Using the patient above that uses Jerry’s ambulance as a means of getting across town, let’s imagine this scenario. Suppose this same patient would call for an actual emergency. Is it really feasible to allow the paramedics to refuse treatment or transport? The scenario brings forth a sort of “Boy who cried wolf” situation. If the paramedic refused transport, the patient could suffer dire consequences and possibly even die as a result. This is just too much of a liability and no paramedic or ambulance provider is willing to take that risk.

Patients willing to abuse Medicaid also have rights that protect them from being refused. Currently, it is unlawful for a patient complaining of an emergency symptom to be denied medical care. According to Medicaid, ambulance transport is included into the scope of “medical care.” And, since Medicaid providers are required to perform all medical interventions covered by Medicaid, they risk losing the ability to charge for Medicaid covered services.

How can we stop the blatant abuse of our Medicaid system?
Stop Medicaid Abuse
The current economy in the U.S. dictates that we must find ways of improving our government expenditures. Finding ways to curb government spending, thus putting money back into the pockets of Americans, is the only way to recover from the current financial situation. If we want to ensure the financial security of our great nation, we must find ways to stop frugal spending and outright abuse that has caused so many problems.

Some possible ways of eliminating or reducing Medicaid abuse and fraud are:

  • One of the first things that could be used to stop Medicaid abuse is a comprehensive audit system. Although there is currently a system in place to perform audits on Medicaid spending, the system is obviously failing.
  • Create a closer working relationship between Medicaid, and providers of Medicaid services. There is no doubt that online filing and billing systems have streamlined procedures between providers and Medicaid, but they have also lessened the contact between the two. With such a robotic system in place, contact between them has been diminished.
  • Stop the current “blanket” coverage that Medicaid currently has in place. By forcing all treatments to first be audited, before being approved for payment, fewer people would be willing to risk having to pay the bill themselves.
  • Enforce consequences to those found to abuse Medicaid. The more people realize the consequences, the greater the chance they will resign themselves from abusing the system.
  • Create a county level Medicaid audit system that can interact with providers. Leaving all of this to a system that is often hundreds of miles away from a provider causes problems.

As long as there are people and options, such as Jerry and Medicaid, there will always be those who try and abuse them. As time goes on, people become smarter and more effective in their endeavors to cheat and abuse the systems that are in place. Only by due diligence and persistent measures can we hope to combat these types of abuses. We have a responsibility to our children’s future to help create a secure and stable financial system for them. We must constantly adapt to needed changes, and stay educated in the means it takes to prevent things like Medicaid abuse.

As for Jerry, he says that he plans to retire as a paramedic. Doctors, nurses, and paramedics alike, have all voiced their concerns with the healthcare system in the United States. But, despite his frustrations with a broken health care system in the U.S., Jerry claims that he still truly loves his job. He says that the personal satisfaction he gains from helping those that need him will always outweigh any political and social problems that medical professionals face each day.

Share your thoughts on Medicaid abuse.

6 comments on “Medicaid Abuse From The Mind of a Paramedic

  1. bondsman on said:

    So if the rest of the County is left with BLS coverage while the Medic plays taxi, why didn’t the BLS truck do the taxi run, leaving the ALS truck to cover the county?

  2. This service only had one truck for coverage at night. There was another service in the county, the fire department, but they only had basic EMS coverage.

  3. Regarding my last comment.

    I think this also lend itself to one of the problems in EMS. In most counties, there is usually more than one ambulance service. Some are privately contracted, and others are municipal. I know of some counties that have as many as 6 or 7 different services, all vying to cover as much area as they can get. They are all left to work it out in a sort of confused territorial conflict.

    I read a recent post at linkedin about regionalized EMS. The idea behind it is basically what emergency responders are suppose to do, but aren’t due to a bit of failed system.

  4. Daniel on said:

    It would be useful if Mr. Perkins would quantify the number of such abuses per 1000 transports, as well as actual costs passed to Medicaid.

    As infuriating as this sort of abuse may be, the potential costs of mitigation could exceed the cost of the actual abuse.

  5. Hi Daniel,

    I wish I could answer your question. However, I am afraid the amount of investigating would far surpass my abilities. There are so many factors that contribute, including:

    Geographic Location
    Population Density
    Other available resources, such as Taxi cabs that accept Medicaid, etc.

    Also, since most counties have several services working the same county, reporting would entail a collaborated effort between them.

    Here lies a problem:

    There are two arguments with a service. If you understand the industry, you will also understand the huge number of private versus municipal funded agencies. Privates firms make their profits from mostly convalescent transports, in most cases. The runs described above would fall into the spectrum of convolescent transports.

    If you are the owner of the private service that is profiting from convalescent runs, then you are likely not to accurately report the abuses described in the article. Quite frankly, they would be biting off the hand that feeds them.

    I myself have worked for several agencies. They ranged from privately owned services in small cities, to county funded 911 services of rural areas, to a private service in a very large metropolis.

    From my experiences, runs like these varied widely from one service to another. The county 911 service I worked for would complete an average of 6-20 runs per day, including emergency and convalescent runs. Of these, only a couple per week would fall into what I would call “abuse” of the system.

    However, the large metro service I worked for completed upwards of 150 runs per day, and nearly 100% were convalescent. Of those, I 2 or 3 would fall into a very questionable category. ie.. Patient only using an ambulance because it was more convenient than providing their own transportation.

    I do not mean to imply in any way that the problems lay on the providers themselves. In almost every instance, they simply do not have a choice. It is a very thin and gray line of negligence when refusing transport to a person for any reason.

    The cost to fix the current system would sure be a large amount. However, I feel that although the initial costs might be cumbersome, the long term benefits would far outweigh them.

  6. Al Wickheim on said:

    In my western-most province of Canada one of the things we find leads to apparent service abuse is the infamous MPDS dispatch system which is basically an insurance policy for the provincially run ambulance service. While for the most part patients, in their own minds, really believe they have a crisis on their hands the MPDS leaves no room for common sense to over-rule the inherent worst case scenario it extracts from the caller. If you are anxious because you have a hang-nail and get all worked up and SOB, and then call 911 ALS, BLS and First Responders all go lights and sirens to the SOB call. For the hangnail. This is no exaggeration. There have been several deaths and untold accidents/near misses as a result and who gets the blame? the guy behind the wheel. On an individual response basis one thinks “just another call”, but in aggregate we and the public are being exposed to far more danger than five years ago.
    Another major fault with this system is this artificial chute-time/response time lark. Never have I seen an assessment of the time since symptom onset been considered. MVA’s are generally called in by everyone with a cell phone and the time delays are minimal but most folks SOB or with various pains, chest pain cardiac or not, have their symptoms for multiples of tens of minutes or even hours prior to calling 911 so in reality what difference does 10 or 15 seconds make to our patient-side arrival? I doubt if anyone can truly say they they got there “just in time to save a life”. Not many at least. In my 30 years of ALS work occasionally minutes have made a difference, but seconds? I don’t think so. That is ambulance abuse at it worst – forcing us to respond to trumped-up emergencies in the name of artificially imposed guidelines threatening the lives of all responders and those on the roads we travel. Keep it in perspective mates, there’s another call after this one!

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