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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsHalifax Hospital whistleblower at forefront of $200M alleged fraud
One woman who works for Halifax Hospital Medical Center in Volusia County sits at the helm of what could be the largest whistleblower case of its kind in the nation.
It's not a seat she enjoys.
Whistleblower Elin Baklid-Kunz, 47, of Enterprise, alleges that she witnessed more than a decade of billing fraud, unnecessary hospital admissions, inappropriate spinal surgeries and illegal kickbacks to doctors, which could amount to more than $200 million in damages.
Most of the bills defrauded federally funded programs such as Medicare and Medicaid.
"I kept hoping someone else would do it," said Baklid-Kunz, who has worked in compliance and revenue services for the hospital, "but sometimes you have to be that someone."
http://www.orlandosentinel.com/news/local/breakingnews/os-halifax-hospital-whistleblower-20130415,0,2352309.story
spanone
(135,844 posts)Baitball Blogger
(46,735 posts)is going to slip off the radar.
redqueen
(115,103 posts)Baitball Blogger
(46,735 posts)The future of this country depends on good people like this whistle-blower doing the right thing. Because, it doesn't look like our political or legal system are up to the task.
redqueen
(115,103 posts)And we need stronger laws protecting whistleblowers.
Sekhmets Daughter
(7,515 posts)The defrauding of Medicaid and Medicare has become a national sport. Such abuse is rife in Florida. I called my doctor's office, about 7 years ago, to make an appointment...there was a brief silence before the receptionist said...Dr.________ is no longer in practice. Turns out he had been taken from the office in handcuffs just a few days before....Medicaid fraud, he and a pharmacist!
I hope Ms Baklid-Kunz is not intimidated into retracting...
siligut
(12,272 posts)The population is more trusting of authority so they don't question what the MD charges Medicare for.
I believe you were lucky not to be under the care of that MD any longer, it seems he lacked integrity.
Sekhmets Daughter
(7,515 posts)And it has been going on for decades... In 1987 a doctor sent in a bill for a triple by-pass for my late mother-in-law. She died on the operating table 1/2 hour into the surgery...he billed for the full surgery... at that time $30,000. It was paid!
Re: my own dr....I was shocked, he was a good doctor...money got in the way somehow. It's sad really.
siligut
(12,272 posts)In Florida, if doctors didn't grow-up there or move there for the easy money, they are changed over-time as they see MDs all around them raking in the cash. The old "everybody does it" takes hold and they slide.
Sekhmets Daughter
(7,515 posts)We need to change our entire medical delivery system...adopt the Cleveland Clinic model perhaps...Drs.are paid annual salaries...get rid of the fee for service model. The AMA says that would create a shortage of doctors...BS, doctors from all over the world would be happy to come here to practice.
siligut
(12,272 posts)They don't want doctors coming here from all over the world. It used to be foreign MDs had to jump through all sorts of hoops to practice in the US, maybe it has changed. I saw too much in my 30 years in healthcare to believe that the AMA is most concerned with the health of the American people.
I agree, we need to change the system
Sekhmets Daughter
(7,515 posts)only one was born here. Iran, Hungary, Russia and Colombia provided the other 4. All were excellent doctors and the one from Iran was a prince among men! He organized the blood workups so that my honey wasn't going for testing one or two times a month. One test was shared among all the doctors. Thus he needed to have blood drawn at most every 2 months, but usually every 3. That alone was a big savings.
Another rip-off are the providers of devices for diabetes or delivery of prescriptions. The waste is atrocious as no one keeps track.
siligut
(12,272 posts)But when every MD owns a lab or a piece of one, it behooves them to draw as many labs as possible. I am glad your SO had such good care
Diabetes type II is a horrible disease and is a cash cow right now, in the US. Lots of money to be made off of misery. Yes, you get the Glucometer for free, but pay through the nose for test strips. Some of the oral medications actually cause weight-gain and not just because they are decreasing blood-glucose. Too many MDs fail to instruct on nutrition beyond the basics. GMOs and hormone fed meat contribute to weight gain and fatigue, but MDs aren't going to jeopardize themselves by saying anything even if they know.
Sekhmets Daughter
(7,515 posts)He was a good man, COPD.
I filled 5 large shopping bags with meds I brought to his pulmonologist...Prescriptions would change, and they would continue sending the old with the new. I didn't have the authority to remove a scrip from the shipment and he, like so many others, was too bitter and resentful about his illness to care about the cost. There were 5 Glucometers, 3 still in boxes...It's crazy.
siligut
(12,272 posts)Patients don't feel the sting and if the practitioner fills out the correct paperwork, the government pays.
COPD is torture, I understand his mood.
Sekhmets Daughter
(7,515 posts)So I couldn't bring myself to torture him about being responsible! I blame the providers! A simple phone call to doctor or patient and the
problem would be solved...but then they wouldn't be making the mark-up.
Egalitarian Thug
(12,448 posts)potential competition, and maximize profits. They are completely unconcerned with quality of care, efficient delivery, or competence of their members.
siligut
(12,272 posts)Mission:
To promote the art and science of medicine and the betterment of public health.
http://www.ama-assn.org/ama/pub/about-ama/our-mission.page?
Taking into account that what you say is the actual truth, then we are back to the AMA policing itself.
Egalitarian Thug
(12,448 posts)In_The_Wind
(72,300 posts)Moondog
(4,833 posts)Baitball Blogger
(46,735 posts)siligut
(12,272 posts)WTF? What about that pesky old Hippocratic Oath Dr Vinas?
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.
http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html
I hope his patients are able to sue him. How horrible to have undergone unnecessary surgery.
siligut
(12,272 posts)Intrinsic to the development of new therapies is the recognition that higher levels of risk and uncertainty are acceptable for treatments for problems for which present solutions are poor. Conversely, new treatments for which standard therapies are highly effective should require rigorous documentation of safety.
The Center would coordinate activities of the National Institutes of Health, the Food and Drug Administration, and Healthcare Finance Administration to ensure their synergistic approach to maximizing the quality of American healthcare delivery. We should set the expectation to continue to lead the world with measurable achievement of goals analogous to our efforts in spaceflight and environmental preservation.
Products and services that prolong and enhance life have obvious fundamental appeal. Instead of a timid, primum non nocere approach to our imperfect healthcare system, let us systematically improve its performance. Carpe diem.
Dr. Eric Rose
Columbia Presbyterian Medical Center
New York, New York
http://www.pbs.org/wgbh/nova/doctors/oath_doctors.html
Thank you Dr. Rose, you are one of the good ones. He wrote this before Obamacare was put on the table, but I believe that his ideals are part of what we might hope for with centralized services. And one of the biggest reasons the RW is against Obamacare? It will drastically cut down on Medicare and Medicaid fraud!