Our goal, as an elder care law firm, is to help families navigate the long-term care process when caring for a chronically disabled loved one.  An unfortunate example of the complicated long-term care health system is illustrated in a February 7, 2016 article in the Philadelphia Inquirer.

Pennsylvania resident, Charles  Prozzillo, a dialysis patient due to kidney failure, required  ambulance transportation three days per week to a dialysis facility.  Prior to December 2014, the transportation was covered by Medicare.  In December 2014, Medicare began a pilot program in Pennsylvania to cut down on what Medicare officials believed was potential fraud and abuse in nonemergency ambulance transportation services.  The pilot program attempted to enforce Medicare’s long-standing policy that required a Medicare beneficiary to require a stretcher for ambulance transportation coverage.  As a consequence, since Mr. Prozzillo could sit up and walk a few steps, he was denied continued Medicare coverage for transportation services.

Since Mr. Prozzillo’s family could not afford to pay privately for the transportation, his daughter and wife attempted to assist in driving him to his dialysis treatments.  On September 21, 2015, while getting out of the car, Mr. Prozzillo fell, breaking a hip, and was subsequently hospitalized.  He was ultimately discharged to a nursing home where he died at the age of 72 on October 14, 2015.

This tragedy potentially could have been avoided.  Yes, if Medicare changed its policy.  However, it may have been possible to explore alternative coverage, including potential Medicaid coverage for transportation and/or requesting Medicare’s prior authorization for a covered service.

Our office assists caregivers in navigating the long-term care system.  Services include health insurance advocacy, how to pay for long-term care, accessing benefits through Medicare, Medicaid, and VA to pay for care.  Our services also include advocacy through our elder care coordinators, experienced geriatric social workers who help families navigate the long-term care system.  Please feel free to visit our website, www.rothkofflaw.com for more information on our services.

The link to the Philadelphia Inquirer article is below.

Rooting Out Fraud Has A Human Cost