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Discussion Starter #1
Ive been reading about a few scams on here lately, and it reminded me of one we dealt with a few years back.

My wife tried to settle her grandfathers estate. Her father dropped the ball and NEVER took care of it,, so about 5 years after his death, my wife was trying to clear things up because some property was involved.

Her grandfather was a federal employee for 40 + years. SO he had a good pension and great heathcare insurance. But he did spend his last 2 years in a nursing home as he was in his 90's and bed ridden.

As soon as she tried to settle the estate and advertised it, a local nursing home claimed his estate OWED them about $60,000 for services rendered because the insurance company didnt pay them.

Faced with having to sell the family homestead from 1840, the whole thing kinda flustered my wife.
It was obvious to me that something didnt add up. Federal employee + great pension + great heathcare = ????? .:confused: So I offered to try and help.

First, I got on the phone with the nursing home and told them they needed to send us the ITEMIZED bills, and we would pay them. They sent them out ASAP. The only problem I seen was, they had billed him for 3 years AFTER his death. This included meals and everything. :mad:

Then, I got on the phone with the insurance company, who told me they DID PAY the bills, but couldnt provide me with any records because it was several years old. :mad:

I waited about a month, called the insurance company back, and basically accused them of NOT PAYING the bills. (more than one way to skin a cat :))

I had ALL the medical bill payment information that same week, including a letter / receipt to the insurance company, from the nursing home stating that all bills were paid in full. . The insurance company was REALLY upset when I accused them of NOT paying, so much they FedEx'ed us ALL the information they had. :D

We then made a nice visit to the nursing home administrator, explained that we were considering sueing, not to mention going public with their scam.

Their 3 year bogus $60,000 bill just majically went POOF ! ,, and disapeared. :D
 

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From Land of Fruit & Nuts
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Nice catch DCD.

I imagine there are a lot of such scams that are successful because no one has the gnarlys to question the issues.

When both my kids were born the process was to bill me and I then send the bills to the insurance company for reimbursement.
For each child I noticed there were significant charges for medications and processes that were not actually used.
The charges were removed both times with a phone call and my detailing the bogus charges.
Since my insurance covered everything, I saved the insurance company from the bogus charges.
I would imagine this overcharging still goes on, but now the communication is between the hospital and the insurance company, so there is no verification of what medications and processes were actually employed.
I was told they do this in an effort to cover uncollected charges to the uninsured

It pays to verify everything, especially with deceased relatives
 

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Discussion Starter #4
Nice catch DCD.

I imagine there are a lot of such scams that are successful because no one has the gnarlys to question the issues.

When both my kids were born the process was to bill me and I then send the bills to the insurance company for reimbursement.
For each child I noticed there were significant charges for medications and processes that were not actually used.
The charges were removed both times with a phone call and my detailing the bogus charges.
Since my insurance covered everything, I saved the insurance company from the bogus charges.
I would imagine this overcharging still goes on, but now the communication is between the hospital and the insurance company, so there is no verification of what medications and processes were actually employed.
I was told they do this in an effort to cover uncollected charges to the uninsured

It pays to verify everything, especially with deceased relatives
I once dropped a piece of firewood on my foot. All I had on were mocasin slippers. It hurt so bad, I thought I broke my foot. At the time, I had Select Blue. So I go into the emergency room and told them to Xray my foot.
The er nurse walks in and grabs the work up sheet, and starts checking stuff off. When she left, I grab the sheet. She checked off about every darn thing on the sheet.

one of the things she checked off was a prostrate exam. No kidding. We had a bit of a round when she came back. I told her, either to Xray my foot like my familly Dr had ask for, or I was calling him immedietly. That seemed to scare her a little. He was on the Hospital board at the time. She took the sheet, and made out a new one, checking only the foot Xray. All I wanted to know was, is it broke , or not. It was Not. So I went home, took some Advil, and nursed a sore foot for a few days.

later, when BlueCross sent me the bill copys,, they had billed for about $500 in pain meds that I never ask for, received, or took. I dont take pain meds, never did. they make me so sick, i puke on the spot.
I called blue cross and told them, they said they didnt have enough people to do anything about false billing.
 

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I would.ve checked in with local DA somewhere along the route before the nursing home. Low quality care and substandard humanity seems the hallmark of such places.
 

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Discussion Starter #6
I would.ve checked in with local DA somewhere along the route before the nursing home. Low quality care and substandard humanity seems the hallmark of such places.
Had it been my Grandpap, I probably would have, but it wasnt my call.
 

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This isn't exactly a "scam" but it's a potentially devistating turn of events if an elderly family member dies...this pertains to California but I understand it's also in place in other states...might pay to check. It's called the "asset recovery law".

This pertains to an elder that receives benefits from Medicaid (not Medicare!) or as it is called in California..Medical. Here's how it works...if a person can't afford medical care and uses Medicaid (Medical) for things like home care, nursing home care, etc...on their death the state can request a listing of any assets the person had and lay claim to it in the amount of the benefits they received.

Often a senior will be ill or injured and have to go into a home...Medicare pays only a very short period of time (like 28 total days for a lifetime benefit) and then the costs (and the facility) will often end up as Medicaid...that's when the "recovery act" clock begins. Doesn't take any time at all in a nursing home to completely use up the "family home" value.

Used to be that people would strip all the assets out of a persons estate before they died but the government got 'wise to that" and now go back 3 years to determine if asset dumping took place..it's a felony.

We had experience when my Mother in Law (92) fell and broke a hip and subsequently died (before she was placed in the nursing home)....as we did the estate work here came the state with a huge set of forms and questions...luckily she had only used Medical as a "back up" to her Medicare for things like medicines (very few) and some oxygen equipment...Her Medicare expenses that were "recoverable" were under the amount that was spelled out and there was no lien placed on her house....had she gone into the nursing home we could not have afforded it and her home (clear) would have become the asset that would have been sold to pay back Medical..

There will be lots of folks that get a big surprise one day as I understand Medicaid is the back stop for Obamacare and the recovery program is going to go national if it has not already done so..

Legit scam.
 

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From Land of Fruit & Nuts
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Good point, opos.
My sister passed in Utah.
She owned her home so the state placed a lien on the property amounting to about $25K for medicaid or whatever it was she collected.
It was paid from the escrow when we sold the property.
 

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Discussion Starter #9
Good post Opos.

They have No qualms about passing crap like that so they can finish STEALING what the elderly worked so long and hard for.

And as the politicians run out of piggy banks to tap, they keep coming up with MORE SCHEMES.
 

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...snip...I called blue cross and told them, they said they didnt have enough people to do anything about false billing.
You should have asked them if you don't pay if they have enough people to follow-up and collect for unpaid bills?
 

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When my mother died several years back I had much the same thing (but with MUCH
smaller numbers). I paid all medical bills for the first two months. Starting with month
three I carefully scrutinized each bill and paid those that I could determine were valid.
By month four I ceased paying any of them.

I got more than one nasty gram about them and I replied the same way: "You seem to
be running a business. WHY then are you not able to bill in a timely manner? I have
paid all bills that I receive in the first THREE MONTHS. Yours did not arrive in that
window. I suggest you learn your business."

Only one complained and then only once.
I saved a few thousand dollars for invalid charges. :D
(happy camper)
 

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My dad passed 10 years ago. He had some outstanding med bills. A collection Company called me not knowing he had passed. They wanted to get in touch with him about paying the bills......Get this, when I told them he had passed away. This is the fun part. The woman wanted to know if he had left a forwarding address!! The sad part was she was serious really wanted to know.. I told her where he went and where she could go the find him. Mind boggling.
 
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