Medicaid. Is it being abused? - page 8

Medicaid was a great idea when first introduced to assure that even the very poor could get quality health care. I just wonder when I see someone drive up in a newer car come up to the triage desk... Read More

  1. by   MedicalZebra
    In 1990, I was thinking about getting married and having a baby. I'd just had a kidney transplant two years before and still had Medicare and CommonHealth (the Medicaid for working people). The transplant clinic told me I should be able to have a 'normal' life after getting the kidney-- and that included having a family.

    I called the Medicaid office to find out if getting married would affect how much I had to pay per month.

    "It sure will-- we'll drop you!" the office worker replied. "If you get married, your joint income will be over the program limits. But..." she said, "You can still have a baby... just don't get married! We'll pay your rent, and you'll get WIC, diapers, a carseat, a crib, baby formula, and baby clothes."

    "So you're telling me to have an illegitimate baby," I said.

    "If you want any financial help, you can't get married!" was her answer.

    So much for living a 'normal' life after a transplant! I didn't get married-- and also didn't have any children. The kidney rejected a year later and I went back on dialysis.

    I am really not surprised that so many unmarried women have kids on Medicaid-- the workers practically call you an idiot if you don't go for it.
  2. by   HeartsOpenWide
    I had a patient on Medicaid (well medi-cal here in California) drive up in a 40,000 dollar truck and then complain that he thought that his wife was going to get their 300,000 house in the divorce.

    But these are my favorite. The patients that come in and cost the state about 80.00 per visit that come in asking for a Rx for cough medicine that they could easily get over the counter, but if it comes in a written order from the doctor medicade/medi-cal will pay for it.
  3. by   kbclary4
    Quote from mercyteapot
    To answer your question, I'm not sure you'd be violating HIPAA if you didn't disclose any information about her condition or dx. That's just my guess, though, I really have no idea. More to the point, I wonder what you think the point of reporting her would be. What do you think they're going to do to her for asking a question? She didn't commit any fraud.

    Would it not have been fraud if she had used Medicaid when she already had another form of health insurance? She didn't commit fraud, but was attempting to as you are not supposed to have Medicaid if you already have health insurance. I may be wrong, but I am under the impression Medicaid is for people who do not have and cannot afford health insurance...not for people who already have and just want something that will get them their meds for free or for 50-cents.
  4. by   mercyteapot
    Quote from kbclary4
    Would it not have been fraud if she had used Medicaid when she already had another form of health insurance? She didn't commit fraud, but was attempting to as you are not supposed to have Medicaid if you already have health insurance. I may be wrong, but I am under the impression Medicaid is for people who do not have and cannot afford health insurance...not for people who already have and just want something that will get them their meds for free or for 50-cents.
    I guess if she had used Medicaid, without telling you that she also had Aetna, that would be a violation of some rule. Asking the question, in and of itself, can't be construed as a violation, IMHO. I do know that there are situations where people have both private insurance and Medicaid.
  5. by   SmilingBluEyes
    I, too, was told once to have another baby to be eligible for daycare assistance when I was a fulltime student. I was told very clearly by the caseworker "all kinds of goodies awaited me" if I would just have one more baby.

    I was appalled. All I wanted was help w/the outrageous cost of daycare so I could graduate and be employed, not "goodies". So yea, you bet like Mercy said, there ARE abuses. And they are ENCOURAGED by some workers to ABUSE the system and HOW TO DO IT. It angers me to no end.
  6. by   selulion
    I, too, fell the need to respond to this. Both of my children are on medicaid right now, and although I am grateful it exhists, I think that medicaid patients may not be recieving equal treatment. My kids have had to wait for appointments to see doctors. I have to take them to the charity hospitals for specialist appointments and wait HOURS to see the doctor. I feel for the doctors that accept medicaid....they are stretched so thin they do not have time to sit down and discuss concerns. My daughter did not have her heart defect diagnosed until she was 4 months old. This was because by then she was so sick she almost died. I brought her to the doctor so often but her doctor just tried to minimize my concern. I cannot wait for the day I can get them on "real" insurance so that they may be treated like human beings. I have no doubt that people abuse medicaid...but if I could afford insurance, I would much rather have it than medicaid!
  7. by   mercyteapot
    Quote from selulion
    I, too, fell the need to respond to this. Both of my children are on medicaid right now, and although I am grateful it exhists, I think that medicaid patients may not be recieving equal treatment. My kids have had to wait for appointments to see doctors. I have to take them to the charity hospitals for specialist appointments and wait HOURS to see the doctor. I feel for the doctors that accept medicaid....they are stretched so thin they do not have time to sit down and discuss concerns. My daughter did not have her heart defect diagnosed until she was 4 months old. This was because by then she was so sick she almost died. I brought her to the doctor so often but her doctor just tried to minimize my concern. I cannot wait for the day I can get them on "real" insurance so that they may be treated like human beings. I have no doubt that people abuse medicaid...but if I could afford insurance, I would much rather have it than medicaid!
    Don't hold your breath hoping that the specialist situation will improve much once you're on regular insurance. I haven't found HMOs to be any better, and in some cases they are considerably worse, than Medicaid coverage. And at least where I live, HMOs are much more common than indemnity plans. For example, here in CA, the children who receive physical or occupational therapy via a Title V Medical Therapy Program can only have program assessments from the specialists if they have either Medi-Cal (our version of Medicaid) or indemnity insurance. No HMOs allowed. What the h*** is that??!! Also, again at least in CA, the Medi-Cal reimbursement rate for specialists is so abysmal (and many children who need specialists qualify for Medi-Cal waivers based on coverage limits of any private insurance they may have through their parents) that many of these specialists have said forget it, and left the state all together. Of course, that means that they are no longer available for any child, insured or not.
  8. by   CyndieRN2007
    quote=treddrn]I just hope that people will realize that the average family in America is about 2-3 paychecks away from being homeless. How many checks, if you lost your job, will it take for you to qualify for Medicaid. For most, 1 month. Just think again, how many paychecks are you from the POOR HOUSE?
    Here's my story. I worked for a company for 6 years, the two of those years I went to school to get my general classes out of the way for the nursing program. I was the primary "breadwinner" for my household. I had insurance through my job. I got accepted into the program and I quit once they could not work with my nursing school hours. I tried to get medicaid for myself and my son and food stamps, which I was given. However they did not recertify the medicaid or food stamps for my son and I because I wasnt working, I would have to work 20 hours a week (my nursing school didnt count, not even my clinical hours). I'm mad because I worked hard for 6 years, single mom, never asked for a thing from the government. Then when I wanted to go to school to make my situation better, I couldnt get help. There are girls who have umpteen kids, housing and food stamps to feed an army. It just doesnt make sense. I just graduated LVN school and I cant even afford to pay for boards. It sucks.
  9. by   ICRN2008
    I know someone who is on Medicaid, lives in a rent-assisted apartment, receives day care assistance and receives free school as well. This is all because she had a baby out of wedlock at a young age. The kicker is that her live-boyfriend has his mail sent to his parents house because they would kick her out if they found out he was living there. She works as a waitress and doesn't report her part of her tip money to keep her income down. Then, she walks around wearing designer clothes and Nike Shox shoes at over $100 per pair... This is abuse of the system if I ever saw it, but she doesn't see anything wrong with it!
    As others have stated, she would lose all her benefits if she got married, so she chooses not to. The government is providing a strong incentive for girls to have out-of-wedlock babies IMO.

    I know other girls of middle class families who go on assistance when they get pregnant- even though their parents could easily afford to help them out. Their parents are the ones who are encouraging it in most cases. Heaven forbid they should have to give up their vacation home or postpone putting a new deck on the house!

    My parents were divorced when I was young and my dad took off after running up the credit cards and causing foreclosure on the house. My mother took a full-time job (and later a second job) and my grandparents watched us some days to save on day care expenses. Even when things were tight, we never were on any kind of assistance. My clothes came from JC Penny Outlet or the thrift store and our shoes were from Payless, and I didn't have cable until I lived in the dorms at college. My sister and I had to go to school early in the mornings to use the computer, because we did not have one at home. I feel that my mother set an excellent example for my sister and me. I credit her for my strong work ethic and my ability to live within my means.

    I believe in receiving short-term help if you really need it, but many people apply for assistance as a FIRST instead of a LAST option or abuse the system (as in the example above). Medicaid and other forms of aid should be reserved for those who are disabled themselves or have disabled children, those who legitimately cannot work, or for the working poor IMO.
  10. by   sydylo
    My children are on Medicaid, but the doctors in the county we live in refuse to take any new patients, and the charity doctors office is not accepting any new patients due to being overfull. We have to drive to a different county so I could get them into the doctors. I know this is due to the state not paying the bills when they come in. I don't take my children to the doctor for every sniffle, only for their annuals and probably once or twice during the year for other illnesses. I have a cousin, though, that is on Medicaid and takes her children to the ER everytime their temperature goes above 100. And she has a regular pediatrician. I just don't understand it.
  11. by   SteveNNP
    OK, I've never been on any type of government assistance, but have seen how when used properly, can be a "stepping stone." What I have a problem with is the obvious abuse of the system by illegal aliens. Not only do they pay NO taxes of any kind, but they come by droves into the hospital, birth their babies on american soil, then leave with WIC, Medicaid, free assistance, now "protected citizens" b/c their kid was born here. We had a mom come in, birth twins on a "two week visit from Mexico" [who travels when they're 7 mos pregnant to another country?] and leave, her kids 3 million dollar-plus medical bills paid for by the taxpayers of the USA. She never paid a tax dollar in her life. I don't have so much of a problem with people using the system if they are a contributing member of society, but freeloaders and illegals get no sympathy from me.
  12. by   mercyteapot
    Quote from SteveRN21
    OK, I've never been on any type of government assistance, but have seen how when used properly, can be a "stepping stone." What I have a problem with is the obvious abuse of the system by illegal aliens. Not only do they pay NO taxes of any kind, but they come by droves into the hospital, birth their babies on american soil, then leave with WIC, Medicaid, free assistance, now "protected citizens" b/c their kid was born here. We had a mom come in, birth twins on a "two week visit from Mexico" [who travels when they're 7 mos pregnant to another country?] and leave, her kids 3 million dollar-plus medical bills paid for by the taxpayers of the USA. She never paid a tax dollar in her life. I don't have so much of a problem with people using the system if they are a contributing member of society, but freeloaders and illegals get no sympathy from me.
    You're citing an example of a woman covered by emergency Medicaid, and the laws concerning that coverage aren't likely to change, ever. If public hospitals are compelled to treat women who present in imminent labor, the only thing shutting down emergency Medicaid would ever do is sock individual hospitals with the cost of their care. That would then endanger the entire surrounding community, who needs that hospital which may have to shut down, instead of spreading the cost of care across the system, as it must be. As far as undocumented immigrants lack of contribution to our economy, I don't buy it for a minute. Tons of them work illegally in agriculture, restaurants and factories, paying taxes under dummy SS #s, doing jobs no American citizen wants. They will never reap the benefits of those contributions the way the rest of us will. It is hardly a black and white issue.
  13. by   roosti2000
    I must agree that a lot of people are abusing the Medicaid. I actually know a person whose doing this fraud. Imagine, her husband is working in a contruction and earning more or less $32K/year. That is the amount that my husband is earning too but we have to pay the doctor per visit $20 as co-pay b/c we have an HMO. Then I asked her if she paid any amount everytime she goes to the her son's pedia and she said no. Another thing, a nurse is visiting his son when in fact nothing's wrong with him. When she gave birth to her son via C/S she didn't pay anything. Me on the other hand, delivered normal, I have to shell out $700+ b/c my insurance did not pay all. I guess this is very unfair to all American people paying their taxes on time and every year.

    Do we have a moral obligation to tell somebody and expose the fraud they are doing? What is the right agency to tell so?

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