Navigating the Labyrinth of Social Insurance

Becky Kelsey is in a great mood this Monday afternoon, laughing and smiling for her mother Jodi. It is a lighter moment in what can often be challenging days.

Becky, who is 33 and lives at home, has a severe form of cerebral palsy. She can’t speak or walk, and she has pulmonary issues and a seizure disorder. For the past 20 years, she has been on a feeding tube. Jodi Kelsey says for years Absolute Respiratory out of Johnston had the contract for Becky’s formula and other supplies, all paid for by taxpayer-funded Medicare and delivered directly to their door. That all changed last summer.

“I’m thinking that Medicare requested bids to save money and the company we were using did not win the Medicare bid, so we were given a list of different places,’’ Kelsey said.
She chose Lincare, a large national company with a local office in East Providence.

“They own a company called Enteral Central, which is where their enteral care comes from. I believe it is in Arkansas,’’ Kelsey said. “When we started a year ago they really didn’t know much about enteral care. I had to speak with somebody in Florida, then they switched me over to somebody in Alabama, and then the food comes out of Arkansas.’’

But the biggest problem was that the cans of formula were arriving damaged. And not just a few.

“We’ve gotten orders of 150 cans where there’s probably between 25 and 50 cans dented,” Kelsey said. “The first few months we got it, cans were crushed and dented. The other supplies were also in those boxes, and they were loose all over the place.”

Of the 150 cans she most recently received, Kelsey counted 68 that were damaged.

Even though there has been no money out of pocket for her, Kelsey has spent countless hours on the phone to get replacement cans after the manufacturer of the formula told her to throw the dented cans away because their sterility could be compromised. She has kept extensive notes of her conversations.

“It’s a waste, number one. And my first question was, ‘Are you charging Medicare twice for cans that I’m throwing away?’ They said, ‘No.’’’

Kelsey filed a complaint with Medicare in January, but heard nothing back. “And I know I’m one person. I can’t fight Medicare by myself. I can’t fight Lincare by myself.”

Now it appears she doesn’t have to. Last month, The Hummel Report contacted Senator Jack Reed’s office, which assigned a staffer to look into her case. The office contacted the Centers for Medicare and Medicaid Services and has been in touch with Kelsey daily, sometimes several times a day. We’ve also learned a Medicare fraud and abuse unit opened an investigation into Kelsey’s complaint. We asked her if she thought she was an isolated case. “No, because when I call (Lincare) I speak to the same girl and she’s doing everything within her power. She said to me, ‘I get a lot of phone calls about this same kind of thing.'”

Kelsey called Lincare so many times that the company did its own investigation — of her.

Kelsey: There was a time when the order was being sent to the local Lincare so they could make sure I wasn’t just saying that these cans are dented.

Hummel: Like you’re going to scam them and get extra cans?

Kelsey: Exactly. Why would I bother?

Hummel: When it’s being paid for anyway.

Kelsey: Right. And they were getting dented cans.

Hummel: So they know.

Kelsey: They absolutely know. I’m not going to let this go because I want to see a resolution. I want to see them do something right. When it comes to my daughter, because I’ve been fighting for her for 33 years, I want it right. I want to make life a little easier for her. I don’t want her to get a bad formula and get sick, so I just keep going. And hope that those efforts eventually pay off.

The Hummel Report is a 501 3C non-profit organization that relies, in part, on your donations. If you have a story idea or want make a donation go to www.hummelreport.org, where you can also see the video version of this story. You can mail Jim directly at jim@hummelreport.org