Monday, August 8, 2011


A little while ago Susan was telling me about yet another ridiculous, time-consuming requirement that's being laid on us by our health insurance provider in order for them to pay a claim. These requirements, if you haven't noticed, have been escalating. The whole idea, of course, is to squeeze more money of healthy people, because remember that one of the foundational principles in the health care insurance business is to avoid people whom are going to generate claims, i.e., sick and injured people. I editorialized when she told me this that "all those health care insurance companies are sonsabitches." Susan seconded the characterization.

Here's a case in point from the front page of the USA Today this morning. Under the headline "Medicare costs for hospice up 70%." That seemed like a huge increase, so I read the article. Indeed, these costs went up by $4.3 billion from 2005-2009. Let me lay this out for you:
  • "for-profit hospices were paid 29% more per beneficiary than non-profit hospices" (Medicare pays for 84% of all hospice patients.)
  • "some of the nation's largest for-profit hospice companies are paying multimillion-dollar settlements for fraud claims and facing multiple investigations from state and federal law enforcement agencies
    • Vitas, the nation's largest for-profit hospice company, is the subject of a fraud investigation by the Justice Department and the Texas attorney general, according to federal court filings
    • Gentiva, the nation's fastest-growing for-profit hospice company, agreed last month to pay $12.5 million to settle Medicare fraud claims, Justice Department records show." (Neither company cared to comment.)
Now here's the kicker: costs have increased because these for-profit hospice outfits have "cherry-picked patients who live the longest and require the least amount of care." These are people with dementia and Alzheimer's who by and large live in nursing homes. Medicare pays hospices who operate out of nursing homes about $3,000 more on average per patient than other hospices. There's also evidence that hospices may be admitting patients (which of course means dollars for these companies) before they meet the criteria to be eligible for this care. The bastards! I'll have more of this rant tomorrow.
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