Free ambulance ride instead of taxi.

[EMS49393]

I don't see medicare abuse (unless the patient resides in a nursing home) near as frequently as I see medicaid abuse. Where I live you can get medicaid for anything. Depression? Alcoholism? Drug problems? Creative physician? You get medicaid. It's super easy to get medicaid if you have never held a real job. Once you're in the work-force, it gets tricky and it's a lot harder to get medicaid and disability.

Our most recent frequent fliers are a set of crack-ho twins and their crack-ho mother. I had the mother while I was working in the ER, she was suicidal because she couldn't score any crack, after being stiffed by a john. She has medicaid. Two days later I encountered one of her daughters while working on the ambulance. I got out, asked her what was going on, and she replied "I'm sick, I got nobody to give me a ride, you need to take me to XXX hospital." I asked her to elaborate on the word "sick" and was told that the other ambulance people don't get rude and ask a bunch of questions they just give her a ride. She told me she had sickle cell, and I asked her if she was in crisis. She replied that she didn't know. Folks, I've been working in an urban environment for a long time, people in crisis know they are in crisis and are generally curled up on the floor screaming in agony. I digress...

Most of are abusers are looking for a taxi ride. They'll tell you they want to go to XXX ER because it's close to their Mom, or a friend, or a pimp. I won't even finish paperwork and they have walked out the door, on their way to their original destination. Unfortunately, we can't refuse to transport these patients, regardless of complaint or presentation. They call, we haul, and they all know it.

The other real advantage to medicaid is that the patient doesn't have to pay a dime for anything. Medicaid pays a certain amount, usually about $55 dollars a run, and we are unable to bill the patient for any portion not paid. Medicare is different, and the patient can be billed.

One problem begets another problem begets another problem. US healthcare is fantastic, if you can afford it, or you have it handed to you. For those that work hard, it's a curse, and a source of much debt for those too proud to go on disability and medicaid.

[spenac]

Use their Medicare and they'll pay out $200 (or whatever it is) and forbid ambulance company from charging more, no matter what the complaint is . . . so yup, free taxi ride. If you were to let them know that it'd be cheaper to take a taxi next time ($30-$40) rather than $800 or so, they're reply would be "nope, Medicare pays for it, ambulance is free".

Unless patient meets very strict standards or the company commits fraud most patients transports are not actually paid at all by medicaid/medicare, as most 911 callers actually could have safely gone pov.

[AnthonyM83]

Unless patient meets very strict standards or the company commits fraud most patients transports are not actually paid at all by medicaid/medicare, as most 911 callers actually could have safely gone pov.

Maybe it's Medicaid that I'm thinking of, but we were told one pays for any ride, but ONLY $200 and by it paying out, by law, it forbids us to charge the patient anything further.

[larry 1745]

maybe thats why i didn't get hired at the local service because I told them i wouldn't be a gerital taxi service because thats all they want the B level people to be so they higher trained personal dent have to be bothered with them, so far i keep going back to them to see if they have any opening and they have treated me like i shouldn't have the certification to work on their service

[Upton4785]

You'd think there would be stiffer penalties for tying up resources like that. Look at my fellow New Hampshirite and all around great-guy Gary Dodds. He purposefully crashed his car and faked amnesia and injury to boost support for his congressional run. Then when everyone found out it was fake, they charged him the money it cost to have all the resources sent out to a bogus call. Should be the same with the people that think of ambulances as taxis. No one but the person doing the abuse should have to pay for them being lazy or cheap.

[Just Plain Ruff]

You'd think there would be stiffer penalties for tying up resources like that. Look at my fellow New Hampshirite and all around great-guy Gary Dodds. He purposefully crashed his car and faked amnesia and injury to boost support for his congressional run. Then when everyone found out it was fake, they charged him the money it cost to have all the resources sent out to a bogus call. Should be the same with the people that think of ambulances as taxis. No one but the person doing the abuse should have to pay for them being lazy or cheap.

Sorry they charged this yahoo Dodds because he had the money to pay the charge, nothing more nothing less. but you get someone on medicaid and just how do you think they are going to pay the fine? Put em in jail for it then? So who will take care of their children?

This is the quandary we are in, do we prosecute and fine all these abusers and never see a dime or do we bill medicaid and medicare and get a little bit of money.

And why are WE collectively complaining about these abusers? Sure we can sugarcoat it and say "It's because of these people who tie up ambulances for the real emergencies which is the real cause of the problem" this I don't agree with. Personally, when I was a new emt and even newer medic I gritched and moaned about the frequent fliers because invariably when I was running hot to Gracie's house for the hundredth time a cardiac arrest or long fall or head on collision always came in while I was running the call to Gracies house and it pissed me off. I was told by a veteran - shut up, quit yer bitchin and be patient, the next code can and will be yours.

I think that for many of us who bitch about the frequent fliers we are really bitching about the fact that "I missed out on that cool call" or I got pulled away from my dinner and I'm pissed.

[BronxMedic]

I had a guy that called in his 80 year old mother as a diff breather twice a month. We'd haul all our gear up the stairs to the shitty third floor apartment, and every time Mom seemed fine and would deny all symptoms. Her son would insist that she was wheezing and gasping before we arrived. Since she was over 65 and a little batty, we couldn't RMA and had to tx every time. Of course concerned Sonny Boy would want to come to the hospital with Mom.

Finally, an ER nurse clued us in. The skel son had ongoing dental work in the hospital's dental clinic, paid for by Medicaid of course, but didn't want to take the subway or pay for a cab. So whenever he'd have an appointment, he'd call 911 for his Mom's "breathing problems" and get a free ride. By the time he was done, she'd be cleared for discharge and the hospital would call a private transport ambulance to take her (and Sonny) home, where a couple of EMTs would have to carry her up the stairs to the shitty apartment.

So that's one 911 medic crew, one BLS transport crew, and a couple of thousand dollar ER visit all courtesy of Medicaid and the American tapayer. Every single time this asshole had a dental appointment. :x

When I retire, I'd love to take a job investigating this sort of thing and arresting abusers. I'll do it for free, just pay for my gas.

[EMS49393]

maybe thats why i didn't get hired at the local service because I told them i wouldn't be a gerital taxi service because thats all they want the B level people to be so they higher trained personal dent have to be bothered with them, so far i keep going back to them to see if they have any opening and they have treated me like i shouldn't have the certification to work on their service

They didn't hire you not because you refused to do BLS transfers, but because you demonstrated bad attitude by thinking you were above that job. I worked on a BLS transfer truck until the day I became a paramedic. Working for a public utility model, I still run BLS transfers, at least one a shift, more if there are no dedicated BLS trucks scheduled.

All that aside, your post had nothing to do with the topic at hand. If you have some experiences working 911 and hauling the same patient 10 times a week to the other side of town just so they can hang out with their homies, by all means, please share them.

There isn't much of a challenge here in the city with short transports and people that are rarely sick, but I'm a city girl at heart. You just can't make up the stuff we urbanites see. :headbang:

[BushyFromOz]

maybe thats why i didn't get hired at the local service because I told them i wouldn't be a gerital taxi service because thats all they want the B level people to be so they higher trained personal dent have to be bothered with them, so far i keep going back to them to see if they have any opening and they have treated me like i shouldn't have the certification to work on their service

Hmmmmmm..... one of the more ridiculous statements ive seen for some time :roll:

[craig]

Her son would insist that she was wheezing and gasping before we arrived. Since she was over 65 and a little batty, we couldn't RMA and had to tx every time. Of course concerned Sonny Boy would want to come to the hospital with Mom.

Trouble with this is that you were not there to see if she did indeed have SOB. You stated yourself that as she was elderly and not quite mentally with it, that you could not RMA her. so what do you do? of course you transport her and her son rides along with her. Here in lies the problem.

So that's one 911 medic crew, one BLS transport crew, and a couple of thousand dollar ER visit all courtesy of Medicaid and the American tapayer. Every single time this asshole had a dental appointment. :x

When I retire, I'd love to take a job investigating this sort of thing and arresting abusers. I'll do it for free, just pay for my gas.

Again I say to you how do you prove this? Yes she was ok by the time she arrived at the hospital (as you said you had to treat her) no wheeze and no SOB. Still they had to do an assessment at the hospital to rule out that she wasnt in any type of resp distress (she was over 65 and batty remember, so how can you trust her responses)

I agree that people that do abuse the system, any system, need to be held accounable for their actions, It is a little hard when the system is set up in a way that allows this abuse to happen in the first place. It is just unfortunate that there are people that know how to use the system to their advantage.

maybe the hospital should say that when he escorts his mum into the ER he needs to stay with her until she is discharged, seeing she is not 'with it' that way he would not be able to attend the dental appointment. That would help the problem would it not?

stay safe

Craig