Sunday, March 25, 2012

Medicaid fraud

There are a lot of rules in foster care. Rules about who can watch over the kids. Rules about how our homes have to be kept. Rules concerning medical issues. (and more rules and more rules and more rules)

Because of Pumpkin's severe medical needs, I've been privy to lots of different doctors and specialists. I've had to bring her to countless follow up exams. Even if some of these exams are really unnecessary, I can understand the extra level of precaution. Every party involved has to cover their ass so to speak. So, when the doctor fills out the medical form that has to be completed at every single appointment, and she writes in "follow up in two weeks" -- I follow up in two weeks.

However, last week, I had to draw the line.

Dude has a wart. A stupid wart on his finger. It's just a wart.

When it popped up a few months ago I didn't do anything right away. We determined that it wasn't an infection (we tried to lance it at home). It was super swollen - but Dude never complained and it didn't move to the top of my "to do" list.

When Dude started wincing as we washed his hands I decided I had better bring him in to get it looked at. The appointment went quickly! The doctor gave me an Rx sample. It's a medication that isn't covered by Medicaid but it was supposed to work really well. Then, on the medical form I have to get filled out, the doctor said we had to come back for a follow up exam in two weeks.

Two weeks?! For a wart?! You have got to be kidding me!

She then added that if the wart isn't gone she'll have to send us to a dermatologist.

For a wart?!!  << sigh >>

So, this past Thursday I loaded Dude and Dolly up in the morning so we could go get Dude's wart looked at again. I wasn't particularly thrilled to be there. As the nurse took his vitals I was a little short tempered. She kept asking questions like, "has he had a change in appetite?" I explained that that ONLY reason I was there was because I am REQUIRED to follow up if the doctor says so. It's only a wart. It's healing. Nothing had changed in the last two weeks!

Got back to the exam room without too much hassle. Yes, the nurse ticked me off with her comment. But really, Dude wasn't phased by it. We didn't have to wait too long for the doctor.

When the doctor came in the room I showed her how quickly the wart was healing. I explained that a lot of the swelling was down. It was starting to crack at the base. I was confident that the wart was going to fall off soon.

The doctor then filled out my medical form. She told me to continue the medication for one more week. And then she said we had to come back again in two weeks.

For a wart?!!

With great disbelief I questioned the necessity of another follow-up exam. The doctor got all "white coat" on me and started explaining that if the wart falls off but the "root" of it doesn't go away that it will just grow back.

Duh. I've got 6 kids. I've done the wart thing before.

Reluctantly I took the paperwork and left the office. Fuming I loaded everyone in to the car. Between the nurse being a bit of a moron and then the doctor milking the system for follow-up exams, I was one peeved mamma.

Enter Rainbow. Oh how I love Rainbow.

I called her as we drove to our next appointment. I told Rainbow all that had happened. I knew that in all reality, it was her job to tell me that I needed to make the follow-up appointment for two weeks out and then keep it. But Rainbow is awesome. Rainbow has a head on her shoulders.

Rainbow was as frustrated as me. She even used the term "Medicaid fraud" before I did. All these follow-up exams aren't necessary. They are just a way for the doctor to make an easy buck. And since these doctors know that we have to do whatever they tell us, unnecessary follow-up exams are rampant.

Rainbow started thinking out loud. My original question was, "What would happen to me if I just don't take him in." Her answer was that we would get a cite in our file. But then she said, don't turn in the medical form. Then, she changed that to, "Why don't you add in the words 'if needed' on the form. Then, if someone asks during the audit, I'll explain that the wart went away. I know you'll take him back to the doctor if necessary. But you don't have to go back in two weeks."

Thank God for social workers who can see beyond the black and white of the rules and use some common sense!! I love Rainbow!

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