Behavioral Sciences: Sociological Issues in America

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Behavioral Sciences: Sociological Issues in America

A large sociological issue that America faces today is the impact made by people abusing the government assistance program. Medicaid was developed as a program to assist those who are truly in need of help in order to survive. Healthcare costs can be a burden to both the rich and the poor. Those costs can often make it impossible for some to seek medical care due to the fact that they cannot afford it. Medicaid was set up to help these people who need help but unfortunately there are many people who are using and abusing this system when they are not truly in need. So often, I see people who are on Medicaid driving Mercedes. This is an oxymoron and a disgrace to the people who really need this. As a nurse working in the healthcare system, I see this abuse on a daily basis and it can be very frustrating and a stressor on the provider. When researching this topic, it is very difficult to find statistics that account for members of Medicaid abusing the system. Most research has been done with a focus on providers such as physicians and hospitals filing fraudulent claims. This goes to prove a dire need for investigation into those who are seeking the assistance from this program. There are very little if any safeguards or follow up in place to monitor the continued need for this service amongst its members. Medicaid is a system that covers it carriers very broadly. Ambulance service is included in these services as well as well checks, hospitalization, etc. Often abuse is seen within the first responder arena when EMS is called to respond to a call yet find that there is not an emergency but someone needs to ride to the doctor’s office and Medicaid will cover that. Patients often get admitted to the hospital on a frequent basis claiming to have ailments with no etiology and come to find out that patient just wanted a place to stay for awhile. So many times members of Medicaid work the system and actively chose not to go out and find employment that allows them to live better. They get comfortable with having medical needs “given” to them and them not having to work hard to pay for them or to afford insurance. Proving this or supplying numbers that show the statistics of such abuse is near impossible. A hospital will not bill in a manner that reflects this patient did not need medical care, a diagnosis will be provided from the attending physician and then the hospital bill is sent. Tracking the number of fraudulent admissions is not possible at this time. It comes down to the healthcare workers seeing this each day in the hospital. The same goes for ambulance services. After speaking to an EMT, they stated that they see this abuse on a regular basis but when the bill is sent, it documents medical necessity therefore, numbers are unknown. A prime example is going on in my hospital currently. There is a patient; we will call him Mr. X. He has been in our hospital during this current stay for about two weeks. This is his 21st admission this year. He is admitted to our hospital when he tells his MD he wants to be in the hospital. He openly tells the staff of this. He does suffer from chronic illnesses but not at the level of him needing acute hospitalization but would be appropriate for a nursing home as he chooses not to care for himself but demands it from others. His MD, Dr. H, prescribes him pain meds each time he is admitted based on his request. Last week, he fired 3 nurses caring for him and called the police 3 times because the staff did not get him his pain meds fast enough. When Dr. H was approached in regards to this, she openly admitted to being terrified of him and stated she will order him whatever he wants to keep him happy. Another example is another chronic patient that admits on a regular basis due to sickle cell anemia. Now of course this disease can be very painful and can require hospitalization. This patient, Ms. S, takes these admissions to a...
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