Senior health care is big business in Sonoma County. Assisted living facilities charge from $3,000 to $7,000 a month for private rooms, depending upon the level of care needed. Long-term care facilities fees start at a minimum $7,000 a month for a room shared with two other occupants. Rates escalate as medical needs arise.
In January 2010, I moved my mother to a long-term care facility in Sonoma. She qualified for county aid and that, combined with Medicare, covered her $7,000 a month rent at the new facility, where she shared a room with two patients.
A general practitioner doctor assigned to my mother began submitting monthly visit fees to Medicare. Another doctor also submitted bills for cutting her nails.
At the beginning of 2011, my mother’s health deteriorated and she became bedridden. At that time, I gave the Sonoma LTC staff oral and written instructions regarding my mother’s pre-paid mortuary and burial arrangements.
On April 14, 2011, I was called by the LTC staff and told to come to Sonoma immediately because my mother was experiencing problems.
When I arrived, my mother was having multiple seizures and they continued non-stop for four hours, during which time I repeatedly asked for a doctor. My request was denied by the LTC nurse who told me that my mother’s general practitioner only came “once a month.”
I asked to see my mother’s medical records and her file showed my mother’s general practitioner had not seen her since January 2011.
By late afternoon on April 14, my mother’s seizures had become so intense that I had to wedge a folded towel between her right shoulder and her skull to avoid additional injuries. By evening I was completely exhausted and drove home to Santa Rosa.
One week later, on April 21, I received a phone call from the LTC facility in Sonoma at 6:05 a.m. telling me my mother had just died. I had medical power of attorney and gave the nurse a phone number to reach my mother’s mortuary in Santa Rosa. The nurse, however, told me they only contracted with a mortuary in Sonoma.
After several calls to hospice for assistance, I drove to the LTC family in Sonoma. When I arrived, I discovered my mother’s body had been illegally taken by the Sonoma mortuary.
By the time I located their facility they had tampered with her body without my permission.
Since my mother’s passing, I have successfully lodged complaints with the California Department of Public Health and the State Department of Consumer Affairs. Extensive investigations by both agencies corroborated my allegations.
This month, I began receiving my mother’s Medicare statements for services from her assigned physician. The general practitioner had billed Medicare for February, March and April, 2011 visits even though paperwork at the LTC facility did not substantiate his claims. The other doctor submitted his bill for a pedicure given to my mother two days prior to her death when she was in a morphine-inducted coma and could not possibly give him permission to do this. No one called me to ask permission, either. I challenged these bills and Medicare is currently launching an investigation.
At a time when our health care costs are rising exponentially, it is our duty as taxpayers to be diligent and report potential medical fraud when we suspect it. As their representative told me on the phone, Medicare depends upon relatives of the elderly to file reports such as mine. Otherwise, they have no way to know about fraudulent charges.
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Francie Aguilera lives in Santa Rosa.