Peace on earth, goodwill to ALL men

About me

Born in Gary, Indiana (but parents lived in Chicago)
Came to Fl age of 5
Graduated from Seminole High School 1960
Graduated from Piedmont College, Demorest, Ga 1964
Attended U of Fla. 1965-6, USF 1966-8
Worked as Utilization Review Medicare) auditor, then Hospital Auditor (auditing charges, and DRG accuracy and payments per contracts)1968-2005.This meant a number of things during the 31 years. I started out with an assignment regarding a hospital owned by physicians who were admitting patients for little or nothing, just to fill their beds. I was in charge of getting the documentation of this. The first couple of years I had some fraud investigation assignments, and even hat to spend some time in Miami visiting patients of a few doctors who were billing for procedures that they had not performed. A local podiatrist was doing the same thing. I remember having to look as several patent's feet in their homes and questioning them, as he had said he did some extensive work on their feet for several hundred dollars, when he had only trimmed their toenails! This case went to court. His father bribed the jury and his wife gave him hell about the whole thing and apparently other things, so he ended up committing suicide. (I was sick about that though).
Later I began an assignment which took me to all the hospitals in my area which numbered in the 40s, to train and assist with a program called Utilization Review (a Federal Program pertaining to Medicare which Blue Cross administered) . This was an attempt to get the doctors in the hospitals to police themselves regarding over use and for quality. Along with that was the requirement for doctors to Certify the continued stay in a hospital was still necessary. This was required at specific times. I was responsible to see that this was being done. So, I set up an audit program whereby I went into hospitals and looked at records on discharged and still in house patients verifying that the form had been completed by the attendings.
Then the audit department formed a more sophisticated audit procedure regarding our private business. In this we got a sample almost always of 20 medical records for review. I would go through these records to virify that every little item on the detail bill had been ordered and performed or used (down to the last pill). Any item that I could not find was subject to review by hospital representatives ( head of lab, head of x ray, pharmacy etc.) If they could not find a way to substantiate the charge, it was called an overcharge. Then these overcharges (and undercharges too) were totaled and the percent of error in the 20 case sample was extrapolated to the entire population of admissions for the period being audited (usually a year) The return to BCBS in my area was over a million dollars each year for the 40+ hospitals. Included with this audit based on counts were differences in prices charged for items which were required to be submitted to us each time prices changed (usually each year). In addition there were items to be included in a procedure, that if found to be billed were considered an overcharge (such as collection devices for lab work).
Finally, the last few years, payment was agreed to be made on the basis of a diagnosis or procedure by what is called DRGs (Diagnosis Related Groupings). With this I would audit to see if the actual diagnosis billed was correct and if the "complications" claimed (which would increase payout) were shown in the medical record. There was not a lot of "cheating" on this, but when an error WAS found it usually amounted to several thousand and even tens of thousands per case. I think I had a 50 thousand dollar refund on one. Much of this was clearly inadvertent error. Almost all "my" providers wanted to get it right the first time.
Bought first home "for our retirement" in St. Augustine, Fl, then others every few years for a total of 6 rental houses (plus buying one for Darlene (daughter) in Titusville area 4 yrs ago, which is now up for sale.
Currently working on resurfacing pool at St. A house, trying to put in shallow well at residence NEAR ORLANDO FLORIDA (previous one caved in with sand).
Tried Opera! Found many Friends. Also, found that normal instincts for me brought many pressures to bear. Having what seemed like harassment, caused me to avoid contact from anyone but closest friends.









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My work

None with an employer, but much for personal!
Mow lawn
Fix broken items
Feed Macaw, who will bite wife, not me.
Clean and chlorinate pool
Maintain vehicles
Clean gutters and roof
Cook every night--few dishes
Unstop plumbing
Put away own clothes / but never never touch washer
Take care of all Rental House needs / inc. collection
Run the vacuum (not auto-pilot)
Watch grand-kids while school is out on some days
Water plants when mother nature doesn't
Clean and clip own toenails and fingers too
Do the bills
Do the taxes
Do the mail
Overdo many things, under do some