By Jerry Schwartz, Associated Press, 05/15/99 16:27
Martha Lawler died in February, on a Friday afternoon, her
body wracked by emphysema. It was the second time in 10
months.
The first time, in April 1998, neither she nor anyone who knew
her was aware of her death. She went along with her daily life
in Indianapolis, breathing oxygen from tanks, making an
occasional foray to a restaurant.
Then, in June, she heard the news: She was dead.
Somehow, Medicare had gotten word of her passing and had
cut off reimbursements for the oxygen that kept this
83-year-old woman alive. When Social Security was informed,
it stopped her monthly payments of $994.
Over the last months of her life, Mrs. Lawler tried again and
again to tell the government she was very much alive; at the
same time, she tried to find out why anybody thought she was
dead in the first place.
She had her suspicions, but it wasn't until a month after she
died that those suspicions were confirmed: After she fired a
hospice company, Odyssey HealthCare, it reported her dead.
The company blames a keypunch error; an investigation is
under way. But no probe is necessary to prove that a dying
woman was forced to endure needless misery because of the
actions of Odyssey and the government.
''No one would help us,'' says Mrs. Lawler's daughter, Jane
Joyal. ''Everyone would say, `Oh yes, it's fine.'
''But it wasn't. It just got worse.''
Her mother had been healthy most of her life. A widow since
1968, she had worked for Indiana Bell Telephone in the repair
department; she raised four children, lived to see 13
grandchildren; and enjoyed the quiet pleasures of collecting
thimbles and paperweights.
In 1992, she was diagnosed with chronic obstructive
pulmonary disease. The downward spiral began - bouts of
pneumonia and then an ever-increasing need for oxygen.
Insurance and Medicare paid the bills.
Two years ago, her health worsened. ''In order to go out, I
would have to take her in a wheelchair to my car,'' her
daughter says. Still, she would go out to eat on occasion, a
small oxygen tank in tow.
All the while, she was in and out of the hospital. But last year,
Dr. Linda Huck told the family she should be kept at home and
made comfortable. She recommended that Odyssey be
engaged to manage her care.
Odyssey has 21 offices, with headquarters in Dallas. Its aim,
according to the company Web site, is to ''serve all people
during the end of life's journey.''
The site poses a frequently asked question: ''Is there any
special equipment or changes I have to make in my home
before hospice care begins?'' Answer: ''Your hospice provider
will assess your needs, recommend any necessary
equipment, and help make arrangements to obtain it.''
And indeed, when Odyssey case manager Debi Vaughn came
to Mrs. Lawler's apartment April 7, 1998, she had a lot to say.
''You do need our services, and this is what we're going to do,''
she said.
You need a new hospital bed, Ms. Vaughn said. And a new
oxygen provider. And we're going to put you on new
medications. The government will pay for it all.
Mrs. Lawler said she wanted to talk to her daughter.
''You need this,'' Ms. Vaughn replied.
(This is how Mrs. Lawler described the meeting to her
daughter. Ms. Vaughn no longer works for Odyssey and could
not be reached for comment.)
The next day, Ms. Vaughn called Mrs. Lawler several times.
Finally, Mrs. Joyal talked to the case manager. Her mother
was happy with her old bed, Mrs. Joyal said, and she wanted
the oxygen tanks, not a machine that produced oxygen, as
Ms. Vaughn had insisted. It was too noisy, and what if the
power went off?
''Every hospice group has providers they use,'' Mrs. Joyal
recalls being told. ''This is our provider, and this is who we will
be using.''
Ms. Vaughn met the next Monday, April 13, with Mrs. Joyal,
her brother and her mother. According to Mrs. Joyal's account,
she finally told Ms. Vaughn, ''Mother doesn't want your
services.''
Ms. Vaughn begged the family to reconsider.
''Your mother is in our computer,'' Ms. Vaughn said.
''Then take her out,'' Mrs. Joyal replied.
''No, you don't understand. She's in our computer.''
Ms. Vaughn was asked to leave, and she did, but with some
parting words: ''You know, Mrs. Lawler, you will be sorry. ...
You do need our services.''
Two months later, June 12, Mrs. Joyal heard from her mother's
oxygen provider, Apria: ''You know, Mrs. Joyal, we have a
problem. Medicare has refused to pay their portion because
your mother is dead.''
Her mother cried. She feared that her lifeline, her oxygen,
would be cut off. (It never happened; Apria continued to make
deliveries, believing it eventually would be paid.)
When Mrs. Joyal called Medicare, she was told her mother
had been reported dead April 13 - the day of the last meeting
with Ms. Vaughn.
Social Security officials said Mrs. Lawler would have to come
into the office, with identification, to prove she was alive.
''It really was an effort,'' Mrs. Joyal says. She had to pack up
her mother, her wheelchair and her oxygen and drive her to the
office. But at least Mrs. Lawler was assured that the problem
had been solved.
Then, on July 3, her Social Security money did not arrive.
Mrs. Joyal called Social Security. Sorry, she was told; Mrs.
Lawler's death was still in the computer, but now it was fixed.
A week later, an emergency check arrived.
Mrs. Lawler was trapped in an endless loop. Each month, her
payment did not arrive; each month, she was told that the
error had finally been fixed. And the next month, it would
happen again.
In September, Social Security deducted $1,988 from Mrs.
Lawler's bank account - the May and June payments she
received after her reported death.
''It was a matter of not fixing everything that needed to be
fixed,'' explains Mary Mahler, a spokeswoman for Social
Security.
Social Security workers deleted all references to Mrs. Lawler's
death from their computer system, she says, but because
Medicare still listed her as dead, the computer refused to
issue her checks.
Mrs. Lawler wrote to Sen. Richard Lugar, R-Ind., requesting
his help. Lugar put his deputy state director, Lane Ralph, on
the case.
Ralph went to the Health Care Financing Administration, which
administers Medicare, and asked: Who reported Martha
Lawler dead?
The answer, as Mrs. Lawler suspected, was Odyssey
HealthCare.
Authorities traced the report to a billing form filed electronically
by Odyssey on April 13. In one field, an Odyssey worker
should have typed 30 - code for ''patient ended services'' - but
instead typed 40.
In other words, ''expired at home.''
According to Pat Skogan, Odyssey's vice president of clinical
and regulatory affairs, this was a mistake, pure and simple. All
other records, she says, accurately explained that Mrs. Lawler
was alive, and had chosen to drop Odyssey's service.
She said the company now double-checks its discharge lists
each month.
''We're a big company,'' Ms. Skogan says. ''Human error does
exist. We're very sorry that this happened.''
Was Ms. Vaughn overly zealous in her dealings with Mrs.
Lawler? Ms. Skogan says the case manager was merely
giving Mrs. Lawler enough information to make an informed
consent, under the law.
Yes, she would have had to change beds. Mrs. Lawler was
renting from one equipment supplier, and Odyssey rented from
another, Ms. Skogan says. As for the oxygen, she says the
company would have arranged to deliver it in tanks.
Ms. Skogan says the Indiana Department of Health and the
Health Care Financing Administration have informally cleared
Odyssey of any wrongdoing. But a HCFA spokesman in
Washington, speaking on condition of anonymity, says the
investigation is not finished.
As for Social Security's role in all of this, its spokeswoman
Mahler says the agency is ''very sorry this happened.''
Mahler says upon receiving reports of deaths, Social Security
does not wait for death certificates. Instead, it cuts off benefits
and relies on the undead to come forward and set the record
straight.
Martha Lawler spent her last months ''worried, worried,
worried'' about her Social Security and Medicare benefits,
says her daughter. In her last days, she did receive hospice
care, from St. Vincent's Hospital. She died at home Feb. 19
and was buried at Washington Park East Cemetery.
It was April 12 - 365 days after Mrs. Lawler was falsely
reported dead, and nearly two months after she actually died -
before Social Security repaid the last dollars she was owed.
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