Problems with Medicaid Affecting Patient Care

Problems with Medicaid Affecting Patient Care | Pintas & Mullins Law Firm

Physicians throughout the country are seeing an increasing problem with Medicaid programs, particularly in hospice and emergency rooms. With the roll-out of the Affordable Healthcare Act, enrollment in Medicaid is expected to increase, further intensifying the program’s problems. Medical malpractice attorneys at Pintas & Mullins Law Firm highlight a few issues brought to our attention by medical experts in the field.

Medicaid is a federal program that provides healthcare coverage for low-income children, adults, the elderly, and people with disabilities. Over 58 million Americans depend on Medicaid for long-term medical health care. Most enrolled truly need the program at some point in their lives to better their health and overall well-being, however, many medical experts are arguing that long-term dependence on Medicaid is hurting medicine.

Several reports from different state research programs reinforce this opinion. For example, the Oregon Health Insurance Experiment recently studied the effects of expanding public health insurance on medical outcomes, health care usage, overall well-being of low-income adults, and financial strain. Among its findings, the Experiment found that being enrolled in Medicaid increased the likelihood that the patient would be admitted to a hospital by 30%, and be prescribed medications by 15%.

Additionally, Medicaid patients were 7% more likely to be admitted to the ER, which is steadily increasing (more on this study can be found here). The problem, of course, is incredibly complex and does not have a single set of easy solutions. As Dr. Edwin Leap writes for MedPage Today, at the heart of the issue is that Medicaid patients do not have ownership of their own health care costs. They are told they have federal insurance, however, they are not fully informed of how the payment processes operate.

Those with more privatized insurance coverage (meaning not through Medicare or Medicaid) try their best to avoid repeat or constant doctor visits because of high co-pays and schedule impediments. Conversely, Medicaid patients are often unemployed because of their disability, or elderly and retired, and are not asked for co-pays during emergency room visits. This leads to a lot of excessive, unnecessary ER visits; Dr. Leap asserts that even a minimal $5 dollar co-pay could help weed out the superfluous patients.

This is not to say Medicaid patients do not need emergency room care. It is widely known, however, that the complete lack of co-pay drives Medicaid patients into the ER who do not have an emergency medical need, causing the department to be crowded and staff to be overwrought. Ambulances are called for fevers, and common depressive symptoms are referred to as suicidal, with demands to be admitted to a mental health facility.

The problem is not limited to a few bad egg Medicaid patients. Physicians and other providers, too, can egregiously abuse the system. The most recent example is Seth Gillman of suburban Chicago, who was charged with defrauding Medicare and Medicaid in his medical facility, Passages Hospice.

Hospice programs are reserved only for patients who are diagnosed with less than six months to live, providing intensive palliative care for the elderly and terminally ill. Despite this, Gillman was billing the federal government for about six years of care per patient, signaling that hospice care either was clearly not needed, or that he was billing for deceased patients. 

Federal data shows that taxpayers were billed $650 per day, per patient, between 2006 and 2011, giving Passages about $120 million in funds. Staff started to notice the scam, and when approached with concerns, Gillman told them to mind their own business and that he needed the money for gambling. Extensive bonuses helped keep some of the more corrupt staff members quiet. Gillman also runs a nursing home business, and is now facing 15 years in prison if convicted.

Our team of medical malpractice attorneys will continue to report on issues surrounding Medicare and Medicaid, as the issue affects all Americans whether they realize it or not. If you or a loved one was seriously injured due to medical negligence of any kind, call our firm immediately, or fill out a free case review on our website. Our attorneys provide free legal reviews and investigate potential cases nationwide.