I think it was here, although it may have been on Poole's forum where we got to talking about Medicare and how so many kids were ineligible in Texas. I remember talking to Flint about how my mom had her toenails cut by a podiatrist [paid by Medicare] who charged $60.00 to just cut the damn nails before she learned of a beautician at her place who would soak her feet, cut her nails, massage her feet, etc. for $30.00. Medicare didn't pay the beautician, but we liked her better. THEN, she was killed in a traffic accident and no one has yet replaced her.

So...Danny T. Yee AGAIN cut my mom's toenails on March 2nd. I'm looking at the Medicare Summary Notice. He's now charging $70.00 to cut toenails, referencing this service as "1 Removal of nail plate (11730)". In ADDITION, he charged $28.00 for "1 Debride nail, 1-5(11720-59)." AFAIK, my mom didn't get anything but a toenail clip, and she now has to pay $97.73 for this because there's the $100.00 deductible that she hasn't met for 2001 with any REAL medical problems.

I ask two things of you. One: Do you see this as medicare fraud? Two: Is there a beautician in the house who could talk me through how to cut the toenails of an elderly person?

-- Anita (Anita_S3@hotmail.com), April 15, 2001

Answers

Anita,

Don't know if it's outright fraud, but it sure smells funny. To prove fraud, though, you'd have to show a pattern of overcharging and/or charging for services not actually performed.

On the second question: believe it or not, Sandy went to school back in NC to become a licensed manicurist, pedicurist and faux-nail technician. (This is before she lost her vision.) I'll refer the question to her.

Generally speaking, it's mostly common sense. The trick is to use straight cutting pliers; DO NOT use those clippers with the rounded cutting face. You want to clip straight across or you'll get ingrown nails.

(Go into the local Grainger or Graybar and tell them that you need a pair of dykes. Don't worry, they'll know what you want, in spite of what it sounds like.[g])

-- Stephen M. Poole (smpoole7@bellsouth.net), April 16, 2001.

Anita-

I think you are talking about two different programs. Medicare is a program for the elderly, blind and disabled (obviously your mom falls into one of these categories). Medicaid is a program for the indigent (like poor kids that meet the federal poverty level). Both programs are forms of federally subsidized health insurance programs that help folks get medical assistance, without having to pay the "full fare" that the uninsured do. Depending on what state you are in, if you are participants in either of these programs, depends on a great number of things. First it depends on your state of residence where you are entitled to recieve this kind of medical care, and how much the state of residence subsizes this care, and how much residual county responsibility there is. You need to check with your local office to find out. Be prepared, that this is not an easy process, or a simple one. So, mixing kids and the elderly are mixing apples and oranges, in terms of prgrams.

As for your Mom's podiatrist visit, there are a coupla things I can tell you from experience. First, "1 Removal of nail plate (11730)". is indeed cutting her toenails. This can be critical for the elderly who may be diabetic, or who because of other disabilities, cannot reach their toes to care for them. The "1 Debride nail, 1-5(11720- 59)." ususally refers to an ingrown toenail. This of course, has varying degrees of being ingrown. Either way, feet that are in pain are not as willing to walk. Many elderly folks have foot conditions such as hammertoes, bunions, arthritis of the metacarpal joints, that make walking painful, if not excrutiating. If you cannot walk, medically, then you are more likely than not to have other medical problems related to their immobility. So your mom should consider the money well spent, because it will probably prevent future problems: she got a baseline look from medical professional in his area of expertise.

So, in answer to your two questions: 1) no this is not Medicare fraud, it is preventative treatment and: 2) I am not a beautician in the house but can tell you exactly how to care for your mom's feet.

First, find a receptacle on which one or both feet will fit. If she has ever been hospitalized, the plastic bath basin from the hospital will work, one foot at a time. Fill the receptacle with foot wash soap or Ivory or gentle castille soap at a VERY warm temp. By the time you get it to them, it will have cooled enough to still feel warm to their feet. Let them soak for at least 5 minutes for each foot. Take the foot out, and gently rub any dead skin away with a terry towel or a loofah (not too vigourous with the loofah tho.) Place the foot on a soft towel, and have a good pair (read sharp) of nair clippers nearby. Following the nail line, clip just above the nail bed. Now this sounds easy, but elderly folks do not always have the symetry of a normal nail bed. Your objective here is to remove the dead/overgrown nail, without cutting into their quick (living nail bed). If it appears that the outside edges of the nail are starting to grow into the fleshy part of toe, this could be a sign of a potential ingrown toenail in the future. You can easily cut a wedge, and remove the dead toenail from the rest of the toenail. Be careful tho, if the person has not had much foot care in the past, they may be extremely sensitive. It could be that the nail has already ingrown itself into the tissue of the foot/toe. If this is the case, call the podiatrist so he can handle it. THIS is not a home task, anymore.

So proceeding, keep the clippers parallel to the nail bed, while they are soft from the soaking, and cut even lengths of nail. IME, be forewarned that there may be unnecsarry wails, which are inappropriate (if you know you are not hurting them ignore it). Once the nails are clipped, apply a smooth lotion or cream, or aloe vera gel. Of course, doing this will enamor your loved one so much, the will never wanna go to the doc again!! (LOL)

When you go get it professionally done, they put your feet in a heated whirlpool to soften them, and then the doc comes in and works on ya, like slicing the old dead skin with a scalpel. But if your Ma has been wearing closed shoes there is probably not much of this, and you can get by with home care. Like any other medical situation, it is a DEPENDS question. You got my e if ya need any other specifics Anita. You need only ask. Hope this helps.

-- Aunt Bee (Aunt__Bee@hotmail.com), April 16, 2001.

Anita, If you really don't like the guy, don't go to him. If you want to hurt him, call the state medical board and complain about his care, then call HCFA and complain that he IS committing fraud. Believe me, between the two of them they'll make his day pretty miserable, and the best part is, he doesn't even have to have done anything wrong.

-- Another (spoiled@complainer.clean.them.yourself), April 16, 2001.

P.S. You can complain all you want, and he can't come after you, whether you're right or totally in the wrong. It's your right, have fun.

-- Another (spoiled@complainer.clean.them.yourself), April 16, 2001.

P.P.S. For even MORE fun, look in the phone book and complain about doctors you've never met, but claim to have been sexually abused by. This works especially well with psychiatrists and ob/gyns. Say "He asked me to pay in cash" (so there won't be a payment record)

-- Another (spoiled@complainer.clean.them.yourself), April 16, 2001.

Anita, A service was performed and Medicare has a cap that they limit how much a Dr. can bill for on any given procedure. Please don't report this man. He has done nothing wrong. He will have to wait many months to be paid and if he is turned in he may decide to stop servicing medicare recipient's. They are becoming fewer by the day and the fact he does care for medicare recipient's is a good thing. Your beef should be with medicare. A licensed beautician may be able to give a pedicure for a lot less money but........ would she be able to recognize diabetic complications? Maybe, but a podiatrist is trained and his cutting your nails isn't just that, he is also looking for telltale signs of problems and using his expertise to keep your feet and you healthy. I have medicare coverage, it is all I can get because of cancer. I have a hard time finding doc's who accept medicare insurance. I have no choice until I am cancer free for 10 years. There are alot of us in the same boat so please, don't rock it...I get sea sick.

-- Marg (At@home.com), April 16, 2001.

Hey Anita, if ya wanna know where your anger should be directed aim it towards the greedy fucking trial lawyers who have sued to the point where doctors have little choice but to charge you outrageous prices. The cost of their malpractice insurance has gone through the roof!

-- Uncle Deedah (unkeed@yahoo.com), April 16, 2001.

Anita, you probably won't like my answer but you would be the one committing fraud not the doctor. The doctor goes through 12 years of medical training and he's charging you for that medical training. The beautician, on the other hand, went to "beauty" school, all of six months. You want medical care you go to a doctor. You want insurance to pay for something that really isn't medical treatment, then you are the one doing the fraud.

-- Maria (anon@ymous.com), April 16, 2001.

Thanks for all the responses. Stephen, I have NO idea what a Grainger or Graybar is. Are we talking about stores here?

This Yee visits the Assisted Living facility at which my mom lives. He doesn't soak the feet. He spends no more than 5 minutes with each person. I'm not trying to get him in trouble. I visited mom on Saturday and picked up her mail, which included the Medicare Summary Notice. She'd used him before she learned that the beautician at her place soaked the feet, etc., and then she switched to the beautician.

After reading your instructions, Aunt Bee, I thought about the time I tried to cut my mom's finger nails. She gasped and pulled away her hand after each snip [and sometimes even BEFORE the snip.] So, who am I kidding? This is my mother, and she doesn't trust ME to not hurt her, and I'm scared to death that I WILL hurt her.

The anonymous poster turned a light on for me. I can't believe I was so stupid as to not think of it before. If her preference is to have her nails cut by a beautician with all the soaking, massaging, etc., why don't I find a beautician who performs these "foot jobs" and pick her up and take her there? It's not like she CAN'T leave the place. It was a matter of convenience to have such things done there.

I understand what you're saying, Marg. There are many folks where my mom lives who don't have family in town and the visiting podiatrist is all they've got. I pick up the Medicare Summary Notices and half the time I don't know if these folks have done anything or not. There was a visiting physical therapist who exercised mom a few times after a leg injury. It seemed like he'd claimed more sessions than he gave, but I didn't report him because he COULD have given the sessions and mom just didn't remember. I haven't seen him around in a year or two, so maybe he WAS claiming more sessions than he gave and someone ELSE reported him.

It seems to me that these visiting providers have the elderly over a barrel. They're the only game in town for many of the folks and the folks can't remember what they had for lunch let alone remember if they had 1 Debride nail. *I* handle the Medicare Summary Notices and they ALWAYS say, "HELP STOP FRAUD: Be informed - Read your Medicare Summary Notice." One of the definitions of fraud is "claims for Medicare services or items you did not receive." How am *I* supposed to know if these services were received?

-- Anita (Anita_S3@hotmail.com), April 16, 2001.

Anita,

Two things: First,if your mom objects to the clippers, try an emery board or reasonable facsimilie. This will take longer, some times folks like the longer physical contact and it is gentler by nature. My grandmother was like you mom when it came to the clippers, but she did not mind the emery board. Sometimes folks in facilities get skin hungry, ya know.

I can tell you how you can know if your mom recieved the services Medicare is covering. Ask the facility (nurses). By federal law, all medical practitioners are required to chart their activities of patient care. So if Dr XYZ bills your mom & Medicare for services on say 4/16/01, ask the facility to check the chart and see if he was there. Easy, no?

-- Aunt Bee (Aunt__Bee@hotmail.com), April 16, 2001.

Aunt Bee: I KNOW he was there. I question whether she had an ingrown toenail [which you said was the explanation for the Debride nail.] I don't know how many people he serves every time he visits, but I know that the place announces that the "toenail clipper" will be visiting and they all line up and sign up for his services. I don't even think half of them know that Medicare pays him. I'm sure some think he's "free."

I've been thinking about this, however, and if a podiatrist can come on a "visiting" basis, why couldn't a beautician do the same? I'm going to call around to some places this week and let folks know that the beautician who once did nail trims died and see if anyone is willing to visit once/month or once every two months to provide the service the folks miss.

-- Anita (Anita_S3@hotmail.com), April 16, 2001.

Medicare won't pay for the beautician. Medicare only pays for services and service providers on their lists. It would have to be an out of pocket expense. BTW debride can also mean filing down a thickened "horny" nail.

-- Marg (okay@cutaway.com), April 16, 2001.

Qualifying for a Medicare providership is a task. Standards of care are establishied, education qualified, and then a permit to bill granted...for a fee. The fee's the key actually. It puts you on the hook for anything that turns out bad. You take the state's money and you're on the dais for every squeak. The fee sucks besides. Better just "doin nails".

Still I sympathize with this dissconnect. In another, Brand Name Prescription Drugs are available for a fraction of their US cost just by walking accross either the Canadian or Mexican border. In this enviornment of course all talk about accoutability is solved with a few bucks.

-- Carlos (riffraff@cybertime.net), April 17, 2001.

I know that Medicare won't pay the beautician, Marge, but it gives the folks a CHOICE. I'd never really thought about beauticians giving manicures and pedicures because I've never gone to a beauty parlor for anything but a hair trim. A few years ago, I was having dinner with my mom and her table-mates and I looked at the Medicare Summary Notice and asked her what had been wrong with her feet. She said, "I had my toenails cut." One of her table-mates said, "He charges $60.00 and I thought that was too much. I've been having my toenails done by the beautician. She charges $30.00. Medicare doesn't pay for it, but she soaks my feet, etc." I looked at mom and said, "Want to try the beautician? I'll give you the money." She said, "Yes."

After I thought about finding a beautician outside of the facility for MY mom, I thought about the folks like Ruth. Her family lives in New Jersey. She would rather pay $30.00 out-of-pocket to a beautician than accept a more expensive service "on the dole". Most old folks take pride in paying their own way if they can. They just aren't always offered the options.

-- Anita (Anita_S3@hotmail.com), April 17, 2001.