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Bending the rules

There is a troubling article in the October Bulletin from AARP that we direct you to, especially if you or someone you care about is nearing eligibility for Medicare.

“Being 'Observed'” outlines a new wrinkle hospitals have put in in an effort, AARP supposes, to overcome potential problems with one of the aspects of health-care reform – a Medicare crackdown on “medically unnecessary” hospitalizations.

Hospitals are subject to penalty for readmitting patients within 30 days, so have now started listing some patients as there for “observation,” not admission. Some of the horror stories that AARP reports have Medicare patients being “observed” for up to a week.

By any reckoning, they are not being observed; they have been admitted.

The problem arises with the realization that post-release rehabilitation is not covered by Medicare, since these folks weren't hospitalized.

The Center for Medicare Advocacy has launched a class action lawsuit against the U.S. Department of Health and Human Services to have this interpretation of the law overturned.

What bothers us as much as anything in this debacle is the now seemingly widely accepted principle that while Congress or state legislatures may pass laws governing your business, if you look carefully enough and hire a sufficient number of clever lawyers, you can probably find a way to subvert them.

We make fun of health-care reform at 2,400 pages. We mock a federal tax code that runs to thousands of pages more. Perhaps these laws are so huge and complex because everyone is out to find the loopholes before the ink is dry.

Is this what business and law schools are teaching these days?

Meanwhile we are asking hospitals in Fauquier, Prince William and Culpeper counties to explain their observation and admission rules for an in-depth story in the next Health, Wellness and Beauty special section, which will publish in this paper on Nov. 14.

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