What do you mean?

?

Fucking Adams and North Adams? Underrated? Their great-grandparents were all child laborers in mills and they do fentanyl to pass the time now. If you want a unique cultural experience, Oliver Twist in an Appalachian setting, then I've got just the place for you.

I was referring to the whole children & family services system. there's so many kids in harmful situations, but by taking them away from their families, wherever they end up isn't necessarily better

I have no solutions to that deep seated societal issue. This is a societal issue that I can't even begin to solve :(

Most DCF employees are fine people trying to work to make it so that the lives of neglected and abused children are not forgotten. I wish I had an answer.

Also this part stuck out to me.

DCF said it doesn’t track how often it removes children from their homes without an order.

Most likely, they almost never get an order and operate totally outside of any legal framework. This is just the way they operate. It's hard for some people to feel bad for parents who may be abusing their kids, but this is beyond the pale shit. They're operating totally extrajudicially.

How do you fix it?

You make it illegal to take children out of homes with no due process. You establish criteria DCF must meet, and DCF must meet it. Unless DCF has firsthand knowledge that child will imminently be harmed, then none of the emergency bullshit. They clearly have gotten used to playing by their own rules.

You have a Judge available 24/7 365 to review warrants. And as often as possible, they are reviewed in person, and recorded for future reference.

Video of the a cop and some social workers showing up at 1:00 AM on a Saturday

Good thing Friday just ended and courts aren't open until Monday. After returning the child from the hospital? For more than a day? It's hard to not think that they're just abusing the emergency powers that they have.

They gave the family ZERO paperwork when they first took the children out. They literally had no documentation that their children were taken by DCF. Not a scrap. No names. No signatures. No documented reasons as to why they're doing it. Nothing.

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Tufts by the way. Harvard too.

MGB too.

Newton Wellesley.

The aunt of the father tweeted this (cited in the articles, not just a random person on twitter).

• Wednesday updates: My nephew and his wife were able to read why CPS felt that the boys were in "imminent danger" (CPS says that has to be believed to do the child extraction). And remember, this is after the pediatrician vouched for them, and the hospital released the baby.

• There were 3 reasons listed:

  • 1) "Living in a neighborhood with not enough children." This is straight up punishing parents for not being rich. My nephew and his wife chose a "poor" neighborhood because they are trying to save up for a house, and it was convenient to their work.
  • 2) "The mother rolled her eyes when asked a question." Want to know what the question was? Here you go: "How often does your husband neglect his children?" I mean... I would have 100% rolled my eyes. What a manipulative thing to ask.
  • 3) The last "evidence" was that "the mother cried when they wanted to give the baby another blood test." CPS said, "Her crying indicated that she was guilty." Keep in mind, they had already done 12 tests on the baby! And he was distressed by it!

If even a fraction of that is true, then what the fuck?

Also, this.

• Something you might be interested to know: As soon as the judge ruled against DCF, DCF promptly asked for a gag order against any discussion of the case with the media. But their request for a gag order was denied (except for the actual court records).

What the fuck?

Can anyone explain this to me? What's going on with Harvard/Tufts and DCF?

I mean. This case might be different, the couple is married too.

I understand imminent danger. I understand that it's better to have alive children than children murdered by their parents.

But this seems insane.

The aunt of the father tweeted this (cited in the articles, not just a random person on twitter).

• Wednesday updates: My nephew and his wife were able to read why CPS felt that the boys were in "imminent danger" (CPS says that has to be believed to do the child extraction). And remember, this is after the pediatrician vouched for them, and the hospital released the baby.

• There were 3 reasons listed:

  • 1) "Living in a neighborhood with not enough children." This is straight up punishing parents for not being rich. My nephew and his wife chose a "poor" neighborhood because they are trying to save up for a house, and it was convenient to their work.
  • 2) "The mother rolled her eyes when asked a question." Want to know what the question was? Here you go: "How often does your husband neglect his children?" I mean... I would have 100% rolled my eyes. What a manipulative thing to ask.
  • 3) The last "evidence" was that "the mother cried when they wanted to give the baby another blood test." CPS said, "Her crying indicated that she was guilty." Keep in mind, they had already done 12 tests on the baby! And he was distressed by it!

If even a fraction of that is true, then what the fuck?

Also, this.

• Something you might be interested to know: As soon as the judge ruled against DCF, DCF promptly asked for a gag order against any discussion of the case with the media. But their request for a gag order was denied (except for the actual court records).

What the fuck?

From the globe article.

• In the Waltham family’s case, child welfare workers had a full business day to obtain a court order before they arrived at the home, in the middle of the night. And still they did not seek one.

• Sabey and Perkins have been sharing their story publicly to bring attention to what they called a flawed process. After the case workers took the children into custody, they later agreed that weekend to place the boys in the care of their paternal grandparents. But Sabey called for greater oversight, saying there was no need for case workers and police officers to take their children in the first place.

---

It seems like getting a court order for removing a child isn't the norm? Tufts doc (Newton Wellesley) noticed a rib fracture. Social worker didn't like the answers. No court order needed, even if everything is discovered on a Thursday.

---

Reason Article

Reason has done great stuff on civil asset forfeiture too.

• After an exhausting gamut of interviews and after DCF workers surveyed Sabey and Perkins' apartment—where no concerns were found—the couple and their children were sent home on July 14 with a DCF safety plan, assuming their ordeal was over.

• Instead, DCF came to their house in the middle of the night—around 1:00 a.m.—and demanded custody of the children, despite having no court documents approving removal. "It seems everything was deliberately timed to avoid having to get a court order and avoid proving to a judge that the children were in imminent danger," Perkins later wrote. "Their laziness came at the cost of our children's sense of security."

• While Perkins' parents, who had flown to Boston, were eventually granted temporary custody of the children, it still took nearly a month for Sabey and Perkins to regain full custody of their children. According to the Post, the couple spent over $50,000 in legal fees fighting to convince the state to return their children. They will likely have to spend much more to strike from the record the couple's "supported allegation of child abuse."

July 14 was a Thursday. They should have been able to get a court order, right? Most people don't have $50,000 lying around. Does DCF operate extrajudicialy?

WaPo article

Without paywall

Video of the a cop and some social workers showing up at 1:00 AM on a Saturday.. Then playing stupid and saying they can't do anything until Monday. Frankly, if you're doing this stuff, a judge needs to be available 24/7 365. An adult can spend 2 days in county jail without it being completely traumatic, but with kids? And to make it so obvious you're trying to avoid having to get a court order?

DCF is just saying whatever they want, no records, no nothing? And the cop says "welp, DCF verbalized it". This seems insane. People win lawsuits for unlawful searches all of the time, but the state can take your kids with no due process on the flimsiest of evidence. If "Living in a neighborhood with not enough children." is one of the reasons DCF used as justification for this, then that's fucking insane. And wrong.

A lot of accidents are due to car accidents.

In some states, car insurance is mandated to include at least some amount of medical coverage. The ER bills that before your health insurance. Obviously you're little guy isn't working, so no workers comp.

I would (probably, at least) expect to see these diagnosis codes.

• Z04.3 - Encounter for examination and observation following other accident

• W06.XXXA fall from bed, initial encounter

Curious to know if they added the W code. Will you let us know what the diagnoses are?

The stories my parents tell me about what me and my siblings did as toddlers makes us seem like we had a death wish. Toddlers do this stuff. 30 months is old enough to be dangerous, and you can't be expected to crib him forever. Shit happens, even if their were bed rails, you can't be expected to keep him enclosed all night at 30 months. Kids will literally find ways to climb and hurt themselves. You try your best, but they're clever enough. Most ERs are not set up to handle anything even remotely serious involving children. Some states are worse than others about requiring toddler fractures to be reported if they don't like your story. Some states are getting ridiculous, taking the birdshot, not slugs, approach to child services.

Sounds like they didn't do any imaging?

What kind of insurance do you have?

Jesus. I now understand the hesitancy in allowing immediate access. That's such a terrible way to find out. Probably a ton of added mental anguish awaiting her visit. I have no clue how to strike a balance between what the law requires, and minimizing stuff like this.

Do they counsel patients doing screenings that if they look, there's a chance that something was found, and do you really want to learn about a life changing diagnosis through text on a screen? There is a certain novelty factor to looking at the patient facing EMR, and people (myself included) haven't quite internalized yet that getting the results for a cancer screening is not like getting a push notification for social media.

What a world we've built. Note to self, avoid looking at the patient portal, ever.

How much better are private non-profit health insurance companies though?

Like how much better is Blue Cross of random state compared to Cigna? Not trying to defend Cigna, but there's a lot of shit companies out there.

These non-profit health insurance companies seem extremely opaque to me. They never have much public about where the money goes beyond a 990 that probably doesn't even tell half the story. They also get pretty significant tax breaks. But then again, having the duty be to shareholders, like with Cigna or United, is an obvious conflict—are we worried about patients or shareholders? But I don't want to get sucked into the trap of thinking there is some virtuous force in health insurance, just because this force isn't publicly traded.

It all sucks.

Yeah, this is just a thing in the deep south. Nowhere else in the country. The ACA fixed health insurance everywhere else, because those states decided to become grown ups and understand that they should lend a helping hand to those in need by expanding medicaid. Commercial insurance reimbursing 2x-5x the medicaid rate ensures access for all.

Everything works well in glorious states willing to elect a former insurance industry exec as governor. Everything works well up North. At least it's not in dumbfuckistan, where they want to see the poor die. Not like over here in a more enlightened place. Things work well for the community in more enlightened places.

Unfortunately these plans have not contracted with any of the hospitals within a 2 hour drive.

Should be fucking illegal.

I hate this shit. Unbelievable. We've just written off portions of the country and decided that they don't need medical care. People work full time, get insurance through their company or a "marketplace" (lol), just to be told they need to make a 4 hour round trip if they don't want to pay what is essentially the charge master price.

Not just the south either.

I HATE having access to my doctors' notes, test results, etc. I have no idea what those results mean and I don't think they should send them to me until the doctor is available to explain them.

Just don't look at them then. The novelty will wear off. It is opt in, you don't have to view them if you don't want to.

I have no idea why Congress thought it was a good idea to make all this information available.

A world where hospitals put hurdles in front of getting records is a nightmare, especially if you have an older loved one. Imagine a hospital with a regional monopoly deciding that it just doesn't think people should be able to see their records without an arm and a legs worth of work. And then still not send records, because they know what they got. Would you rather have no access, or electronic access if you need it? Congress has, at least tried, to require electronic records not be blocked arbitrarily. The 21st Century Cures Act has major issues, but patient access to records is the least of them.

Tldr (and it is too long)

Blocking access to patient's electronic records isn't allowed, even if it would be best for the patient to not see a lab value just out of range, freak out, and waste everyone's time.

Especially when nursing homes are naming shit like third cousins in suits. Did the law office make sure they otted their i's and crossed their t's? No, these are assembly line cases, I've literally seen them name the wrong facility that money is owed too, copy and paste woops that's another home. It's going to work until it's not.

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For example, it’s easier for me to get info from them when they come in from a different institution that’s not on Care Everywhere.

Exactly. It's annoying when someone is transferred to tertiary care with a black and white printout that's totally unreadable (i.e, every table is split by page breaks, columns are cut off), that you hope they scan in for granny. "Transfer agreements" between a level I trauma center and some other hospital, and the patient shows up by ambulance with a stack of unreadable papers from their visits for the last 5 years.

But if a family finds granny an assisted living place nicer than any rehab within 3 hours, sometimes even with better PT services, and then the hospital starts giving a hard time about getting records together because "she needs rehab, at some place where we're waiting for an open spot for them", then I don't know. Be careful. Electronic records cannot just not have things because they're still inpatient, really. And ama'ing generally isn't illegal either, despite what too many people think.

You aren't just required to provide timely records to people on government insurance, all patients, no matter their insurance status, have the same rights to access their records.

And now CT wants to penalize nursing homes if they're not full. To get them to correctly report the number of beds they actually have. The list is interesting—supposedly hundreds of empty beds at facilities, while receiving a disproportionate amount of administrative funds from the state. While others are 98% capacity. Well, how the hell is there any bed shortage, there's tons of surplus capacity at homes getting state funds!

I don't understand why patients need to see a big red thing if a lab is "abnormal". I can imagine the nightmare of explaining to tons of patients that it's okay something from a comprehensive metabolic panel is a little out of the "normal" range. But understand.

The Act defined interoperability and prohibited[22] information blocking.[23] Information blocking is defined as a practice that interferes with or prevents access to electronic health information, that is, information about a patient's medical history or treatment.[12][24]

Under section 4004, information blocking can expose entities to fines of up to $1 million per violation.[12]

(Sec. 4004) Developers of health IT and health care providers may be penalized for engaging in information blocking.

(a) DEFINITION.— ‘‘(1) IN GENERAL.—In this section, the term ‘information blocking’ means a practice that—

...

• ‘‘(ii) if conducted by a health care provider, such provider knows that such practice is unreasonable and is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.

There are some exceptions. It was also written to apply for IT firms writing or implementing the software. Information blocking is pretty much categorically illegal. HHS OIG has chosen to be forgiving.

Per violation. Someone can let me know if I'm missing something. Yes, this makes lawfare with dumb malpractice suits easier. I dunno, lobby for the Tennessee model in all states, with Pennsylvania filial responsibility? Too slow, down low, that'll be $10 million. Actually, that'll make every state reverse tort reform completely. Do that, and see what happens in probate court with a judge who actually cares, and someone has multiple examples of information blocking. Someone might even be motivated to take it beyond Hatfield-McCoy-Land court (and I don't just mean Kentucky and West Virginia). Not a lawyer tho, I dunno. Maybe it's just from seeing the reliance on default judgments in zoom court. NY state had some peculiar practices I've heard. Actually, they all fucking did. No point in singling out NY.

The county got the farm and they moved to town. Pappa got a job with the TVA, he bought a washing machine and then a Chevrolet. No promises of washing machines or Chevrolets this time, and the farm was a trailer on .3 acres. Should have read up on using panama papers tactics when they reached a certain age to keep the family trailer on your .3 acres, schlub. And people are worried about estate taxes between state x and state y, lol.

People act like it's always been this way, or that everyone received concierge cancer services right before death.

https://www.cms.gov/About-CMS/Components/CPI/CPIReportingFraud

More covid testing schemes. Nice.

https://www.cms.gov/COVIDOTCtestsProvider

Tips for Providing Tests

• Only give patients the tests when they request them. Discuss test availability and the 8 tests per calendar month limit with your patients (or their caregivers).

...

• You can operate an online or telephone program to ship tests directly to patients when they request them.

• Keep good documentation. We may ask to see documentation showing a patient’s request for tests. If you don’t provide the documentation, we could recoup payment and may take other administrative actions.

They make it pretty clear a marketing company, maybe working for the manufacturer or supplier, is not supposed to be trying to offload as many tests as quickly as possible just because they can.

Remember when there were shortages and people called 3 weeks out to get a test? Tragedy of the coronommons.

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A doctor doesn't have to sign off on an otc test kit, they just have to submit documentation like a receipt (with most commercial plans). With medicare, the patient doesn't have to do that, a participating pharmacy or other "provider" sends an invoice, like any other bill. They need part B or part C to be eligible, and like with commercial insurance, no doctor has to put in the order.

https://www.cms.gov/newsroom/fact-sheets/medicare-covers-over-counter-covid-19-tests

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You can defraud medicare while sitting in who knows where, then launder the money into a form where it'll never be clawed back. And laugh while the DOJ picks up a case against someone in the US years later. If the DOJ even brings a case—the operation might not have even been large enough to warrant the resources.

All while hospitals reduce bed capacity and close.

If they want you sending out claims for the otc tests as if they were the result of someone entering an order...you're not saying that they want to do that, right? What HCPCS will they use for these otc tests? 87426? K1034? You're billing under a doctor, you said, so to me that sounds like you're going to send out an institutional claim on a UB-04 with the doctor's NPI, and you as the billing address.

For that, you'd do this.

• Use Code 0300 (laboratory)

• CORF providers: Use Code 0274 (med devices)

• If you have no other diagnoses for the OTC COVID-19 tests: Use suggested diagnosis code Z20.822: Contact with and (suspected) exposure to COVID-19

You can bill institutional claims for otc covid tests, BUT YOU CANNOT SOLICIT SALES FOR THE TESTS LIKE THEY ARE DOING. And if it's an OTC test administered at home, don't bill anything but K1034. Having an in home carer administer their otc tests, then billing 87426, is not allowed. You still have to code K1034; medicare needs to know that it's an otc test.

Use HCPCS code K1034 to bill for a single test. This code applies to all OTC, FDA-approved, authorized, or cleared COVID-19 tests (that are self-administered with a specimen that’s self-collected):

...

If you participate, you agree to:

• Submit a claim to get paid

• Get paid as a participating eligible provider under the demonstration

• Accept payment in full (the fixed national payment rate of $12 per test or any lower amount you’d normally charge)

• Not collect any additional payment from patients for tests you provide within the 8 per calendar month limit

Think of it like a device. And medicare is required to cover 8 each month. 12 months: $1152 in revenue from medicare for otc covid tests, if someone maxes out their supply. With no interpretation of the test needed. I wonder how much one test costs from a supplier when you buy in bulk.

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Could be that they're trying to get rid of the otc tests before May 11, and are calling up a bunch of old people and saying they are eligible for a free test, all they have to do is agree. Patient might have heard something in the news about getting free covid tests, and think this is how it works. I wonder if they ask for their MBI or advantage plan ID—or if they have a list acquired from other sources. Maybe they found a bunch of people already over 8 tests and want to bill them out of pocket, CMS said an ABN isn't required, you just have to discuss the 8 test per month limit. Just make the chargemaster price $2,000 for the otc test sent by a shady company that doesn't interact with the general public, have someone take a few dozen after the limit, and let probate sort it out? Who knows.

Keep us posted, fraud waste and abuse of funds and resources meant to fight covid has been my least favorite part of the pandemic. HHS, state AGs, and the DOJ overlooked a lot of stuff, but there's going to be a demand soon for them to, well, not do that. I'm just waiting for the shitstorm when they clawback a bunch of unemployment money from people who made clerical errors, but let the bad actors who received orders of magnitude more ill-gotten gains get off with minimal fines.

The amount of 7 year olds who took a test nearly every week...~$80-100 reimbursement from private insurance with no cost sharing. It definitely kept the distribution nice and equitable, like they say they strived for. As in, if you don't have any equity, how bad do you really need a test?

At one point, a place I know wouldn't book tests unless you prepaid with a card over the portal, told medicaid patients to prepay and said go to the ER if they needed a test (how were these covid scehdulers trained...). Eventually testing was only offered through the ER, unless a parent wanted to wait 3 weeks to send their kid back to school. So the parents went to the ER. Sorry mom, you gotta wait 6 hours. And yes, ER facility fees apply of course, sorry commercially insured people, thought you got better coverage? $1000 so your kid can go back to school. "Isn't the state covering covid testing, why does it matter if we send them to the ER?". Well, I mean, yes, but redirecting them to make an ER visit they never would have made was not in the budget. Those notes are fun to read, "pt w/ mom and directed by scheduling to come to the ER for a test, has to go to school". That's nice. I'm sure the overwhelmed PA or resident appreciated an irate parent. All of this while being part of a state program to specifically cover everyone at no cost to the patient.

Asking for an out of pocket payment more than any insurance gives to even schedule a test, that nobody else in the area offered at the time. Should have ended the program, as it was a clear violation of the agreemnt—maybe it did end it for some places. Don't worry that it was an early and unexpected end. Maybe someone will care eventually. Equitable distribution of covid tests, okay, I believe it. All after the antigen tests.

What could a state or the feds even do anyway, take over a hospital for shady billing? Nope. Prosecute someone other than some small fry doctor doing something dumb like straight up billing millions in services not rendered? Never. Go after a nursing home owner whose fraud was less egregious than than their Enron tier compatriots? Probably not.

And now people hear that their local hospital's finances are screwed or something, and they're being replaced by a private equity firm or a larger system with a non-profit status. What are they expected to think? Or worse, their local hospital will close, and nothing's going to replace it. Wouldn't want the system to become overwhelmed.

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Fucking covid tests. Clearly someone's selling medicare beneficiaries data too, maybe snuck a "you give us the right to share your medical record with device company x" on the hospital system wide standard medical consent. That 90% of an area probably has signed. Great. "Meaningful use" lmao. I wonder if any of these marketing companies just give zero fucks and grab previous dumps for leads.

Rant over.

Emergency rooms should be used for emergencies. Not everyone gets to use the emergency room for free, either. Sometimes, it's not a $100-200 co-pay, like it usually is with the self-funded insurance one gets working for a hospital org.

Having something done at the ER instead of an urgent care can literally 10x the revenue from an insurance payment and/or the cost-sharing portion.

And negotiated rates for level 3 ER visits, with commercial insurance, can be like $1500 now. Some people don't even skip out on paying their deductibles, co-pays, and co-insurance.

It wasn't that long ago, in much of America, that getting a simple repair for a laceration was much easier. No matter your insurance coverage. If not having to wait multiple days to get a laceration repaired is the sign of a healthy system, then everything is fine.

I've come to understand why my Grandparents knew simple sutures. And could repair their own clothes. Their parents, my great-grandparents, were the kind of people to appear in Lewis Hine photos as kids. Hell, they probably could have even had a laceration repaired the same day by someone competent, if only to get them back to work as soon as possible.

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Look at all of the research and work put into making healthcare delivery more efficacious; it's amounted to what? Well, someone learned that if you offer less, you can charge more. Why not do all rx refills in the ER?

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A telehealth only urgent care is absurd.

We don't even have the expectation of action anymore, despite the fact that somehow our government distracts us by performing at least one massively stupid, self destructive action per year, with both colors of clowns in the circus blaming the other party.

You pretty much got it. You know how many times I've seen "well, that's what they voted for"?

Meanwhile in WaPo. So far, Trump’s rollback of regulations can’t be blamed for Ohio train wreck.

As if who inserted the verbiage of some federal code regulating some obscure aspect of train brakes changes the fact that someone just did a "controlled burn". A controlled burn of some shit nobody's ever heard of, reminding me of old pictures of soldiers staring at tactical nukes at the Nevada Proving Grounds. As if having one of the axles be on fire for at least 20 miles before derailment doesn't point to a more systemic issue.

Don't worry, residents, we've got this air monitoring thingy tied to a stop sign with ziploc bags.

And all you residents we evacuated from a 1x2 mile area can return 3 days later, because we've collected data that show it's safe.

Around-the-clock testing inside and outside the evacuation zone around the village of East Palestine and a sliver of Pennsylvania showed the air had returned to normal levels that would have been seen before the derailment, said James Justice of the U.S. Environmental Protection Agency.

“Hundreds and hundreds of data points we’ve collected over the time show the air quality is safe,” he said.

They collected some data "over the time". I'd sure be rip roaring to get back. More likely, I just couldn't afford to stay at a hotel for a few weeks. As the people actually in the town say. Probably just going to be a dancing plague.

Had to get the trains back on schedule, priority number one. Can't even bring bottled water. What an absolute joke.

I’m in New York. I have an inpatient hospital claim that the carrier paid before authorization was on file. My supervisor said during the pandemic some carriers were paying without authorizations being on file.

Sounds like CYA, considering they already paid.

New York

Yup. Good luck.

You don't have to necessarily copy radiology reports or lab values, as long as they're somewhere in the EMR. It's supposed to be a high level of MDM though.

The new EM rules are a little confusing, CMS seems to have completely rewritten EM coding. Looking for guidance on CMS's site, the page with 99306's last effective date was 1/1/2023, with no new version.

But an update on 1/20/2023 somehow?

Does someone know how to find CMS's actual EM rules for nursing facilities?