Elderly Americans experience about 29 million falls per year, which costs Medicare $31 billion. At about $1,000 per fall that seems quite reasonable. 27,000 older Americans die from falls each year. In an institutional setting like a nursing home, the rate of death per fall is even higher.
$700,000 for two people in assisted living for eight years is about $43,000 per year. That's not unreasonable for the cost of assisted care plus medical expenses.
A facility generating large numbers of fall investigations that don't lead to ongoing medical care seems like it would be pretty easy (potential) fraud to go after though.
However, medical expenses are top heavy. Some of those falls probably cost 200,000+$ because they cause long term medial issues. If a faculty is spending ~1,000+$ on an a median fall their average is going to be much higher than that. Which is a sign they really are providing unnecessary procedures.
https://www.medicare.gov/about-us/how-medicare-is-funded/med...
FWIW: I advocate single payer (Medicare for All), but not single (sole) provider.
Oh, but it gets worse. It's bad enough that the government is being bilked for hundreds of thousands of dollars on behalf of those without the ability to pay, but even for those with significant assets, there are "perfectly legal" tax dodges that can be set up for $XX,XXX so that Medicaid pays the $XXX,XXX bills while the family inherits the $X,XXX,XXX estate. And if you pay the lawyers a little more, they can probably even figure out how to avoid paying capital gains on the distributed assets if they are below $10 million.
I don't see much hope for the insurance reform in the US until we can get end-of-life costs under control. I don't if "Ponzi" is quite the right term, but it's definitely a system rife with fraud.
More generally, "House of God" is a stunning inside look on how the US medical system actual works: http://slatestarcodex.com/2016/11/10/book-review-house-of-go...
I'm actively against the "bowel run" mentality. I do my best to avoid even the CYA test ordering, though I'm not in the ED where this can be the most rife. I see first hand the "ponzi scheme" (though IMO it is not the correct term) of the system and I chose to go into primary care because I actively want to fix this in any way I can, and being a specialist was not the way I thought would be best to do this.
Medicaid does.
Medicaid is the payer of last resort for nursing care though, not Medicare (which doesn't really cover long term care).
Capital gains costs bases are currently "stepped up" during the estate transfer. No need to pay anything to lawyers. If your estate is below $10.5M (or thereabouts, I forget what the exact number is since it's now inflation adjusted), you won't be liable for any of that capital gains, nor will you owe any estate tax since you're within the exemption.
Despite this, do read "House of God" --- it's a terrifying and eye-opening book!
In the past, transferring assets to such a trust entailed gift tax, but since the estate tax and lifetime gift tax exemption are now bundled together, you can basically "use" the estate tax exemption to fund this irrevocable trust "for free". As a result your personal assets plummet, you name your heirt the beneficiaries of the irrevocable trust, and you (the parent) can take advantage of medicare fully as you describe.
The drawback to this strategy is that you do lose real flexibility in controlling your assets. Also, the legality of this widespread practice is definitely in a gray zone and carries future legal risk. Transferring a significant portion of one's assets to such a complex instrument is definitely not advised.
While Medicare covers almost all of it, it became so nauseating to read the outrageous EOB totals that I tried to put a end to it - I requested that unless the on call nurse (after hours) or physician (during business hours) deems the fall to be a life threatening emergency, they are to be kept in the facility.
They found a workaround for that real quick - it's nearly always deemed life threatening because they are 1) unable to determine internal bleeding 2) unable to determine if a bone was fractured/broken.
The obvious solution to this is to have an xray machine on site, because since everyone in the chain gets paid huge $, and it removes the liability from the nursing home to ship them off to the hospital, the merry-go-round of insanity continues. We have two family members in an assisted care facility for almost eight years now, and between the two of them, they've tapped Medicare for just under $700K. Together, the sum of both their incomes throughout their entire working lives never totaled that amount. This is why I call it a ponzi scheme.