The Oregon Health Plan?

By Sheriff Mike Cook
for Sierra Times

12/19/03

Something was brought to my attention last week by a friend. First I will say I only have one side of this story but it sure has a ring of truth to it. It also shows how the government system of socialized medicine can be abused. So I have changed the names and locations so no one will suffer for telling me this story. Many people still have a lot of trust in me as a retired and honest police officer, that's why I learn these things.
The background on all this is The Oregon Health Plan and Medicare. Now remember the Oregon Health Plan was authored by a medical doctor turned politician who became the governor of Oregon. Medicare is also set up and run by the government.

In this small local area the medical doctors and professionals have set up an oversight program to deal with these government agencies. For lack of a better word lets call this the DOC's program. Now this agency does all the foot work getting the state and federal money and making sure people who are under these programs get services. They hire an accountant to manage the program and a nurse practitioner to assist in making the organization work. They then sub-contract with local business's to provide services to the patient like prescriptions, wheel chairs, and even depends if needed. This organization is like our HMO's from insurance companies. This is where the abuse starts.

Also if you come to the area where this DOC's program is set up as a doctor and set up a practice you are encouraged, should we say, to join this organization. If you don't then no other doctor who is a member will help you by taking duty for you so you can have a vacation or a day off. One doctor was forced to leave the area because he wouldn't join in this organization. Sounds kind of like a union closed shop to me.

When someone goes on the Oregon health plan they are sent to a medical doctor to be given a physical and evaluated. The doctor then decides what level of service this patient needs. For the sake of this story lets say the doctor feels that this person needs $1,000.00 worth of medical services a month. Then the DOC's organizations sets this up with the Oregon Health Plan and they are paid the $1,000.00 per month for this patient.

Now lets say that if the patient doesn't use $1,000.00 worth of service a month then the money that is left over is split between all the doctors who are members of this DOC's organization and the manager and his helper gets a bonus out of that money. Now do you start to see where this could be abused.

Now if you are a small local business that is under contract with the DOC's to provide a service like (Depends) or other things that patients may need and the doctor puts in a prescription order for say four (4) depends a day for a patient who is incontinent and DOC's decides that you only need two a day and changes the order. Then your care giver calls and tells the provider (small business) that they need more as they are running out. So they are sent over, however the DOC's won't pay for them because you were never authorized to send that many. So you call next time and are told by someone on the phone at DOC's That you always have prior authorization to do what you just did. Then when you give them the bill the refuse to pay it. So you raise a stink and start getting people like your elected representatives involved. Now comes the fun part.

Before long the state auditors are knocking on your door to check your records which they have the right to do. You let them in give them a desk and provide everything they ask for because you have nothing to hide. They then leave after a couple days and you are notified that the auditors found where you made some mistakes in your records and they think you have over charged the DOC's and therefore the Oregon Health Plan $3,500.00 and they asses you an extrapolated fine of $500,000.00 dollars. When you ask for a hearing on this they go over the audit again and decide it is only about $1,200.00 so they lower the fine to $190,000.00. Then you find out another business like yours in eastern Oregon is audited and they found a $700.00 over charge and fine this business $79,000.00. These fines will put you both out of business.

Then we find out that the DOC's is organizing to get a law passed that they only have to deal with one company for all the business they do and that company may be in Ohio or some place, effectively putting all the small business on a local level out of business from then on. This is what we can expect from socialized medicine in this great land of ours.

This may be going on right here in Coos County Oregon. I don't have all the facts but this sure needs to be looked into. There is even more to the story than I have said here as this is a very abbreviated account of what is going on. Our local medical people are being paid for services they don't provide on our tax dollars and others are getting rich off our tax dollars by abusing the system. Like I said from the get go I don't have all the facts and I only have one side of this story, however it sure looks like something is rotten in Denmark to me. Perhaps someone out there would like to investigate this and see what can be done.

God Bless America

God Bless Our Troops still in harms way.

Michael E. Cook, Coos County Sheriff, Retired.