Medicaid. Is it being abused? - page 9

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   mercyteapot
    Quote from 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?
    You don't have any proof that there is fraud. She may qualify for Medicaid under a waiver program. It is only fraud if she lied about her income on the application, and you haven't told us that any such thing has happened. As for the home visits, that may be something that is covered under your County's public health program. At any rate, it certainly doesn't sound fraudulent. If I was manning the phone of an agency you called and reported this limited information, I'd probably ask you what, exactly, it is that you think should be done.
  2. by   grannynurse FNP student
    Quote from mercyteapot
    You don't have any proof that there is fraud. She may qualify for Medicaid under a waiver program. It is only fraud if she lied about her income on the application, and you haven't told us that any such thing has happened. As for the home visits, that may be something that is covered under your County's public health program. At any rate, it certainly doesn't sound fraudulent. If I was manning the phone of an agency you called and reported this limited information, I'd probably ask you what, exactly, it is that you think should be done.
    I would really like to see all these people who are receiving Medicaid fraudently, really I would. I live and worked in home health, in NYC, for several years and rarely if ever saw anyone obtaining benefits fraudently. And I never saw any of my clients driving big, fancy, new cars or the finer cuts of meat. I did have several who used dog food stew as a base for their own. And I worked as a rehab nurse/case manager, here in Florida, for ten years. And you would be surprised at the number of my clients that lived close to the edge or were pushed over it. I had several, who despite working forty hours, qualified for public housing and food stamps. And when they went on comp, qualified for Medicaid. I qualified for Medicaid for a whole 18 months, until I qualified for SSDI. Kind of hard to live on $296 a month.


    To be honest with everyone, I am sick and tired of a few complaining about another few and acting like they were the majority. If you feel some one is receiving Medicare, Medicaid, food stamps, public assistance fraudently YOU HAVE THE RESPONSIBILITY TO REPORT IT TO THE APPROPRIATE AUTHORITY. Thar is medicare, medicaid, your public assistance office, your state attorney general. And you don't have to give your name. All you need is the name and address of the suspected person or persons. You can even send a letter in. And while you are at it, take a look at the facility you work for and their /mistakes'. It is funny how they keep making the same one over and over and over-------

    Grannynurse
  3. by   P_RN
    I'm totally disabled and get Medicare. It's no walk in the park I will tell you hthat. The looks I get from drugstore clerks, office assistants, hospital clerks shrivel the soul. When you get SSDI you have no choice to get Medicare. If you don;'t then they treat your bill as if you have it and you are responsible for the difference plus what Medicare would have paid.

    I don't qualify for Medicaid, but I'm trying to get it for care for my Mama. I can't handle her physically and she is draining me emotionally. At $900 mo SS bbefore the $88 for Medicare she makes just borderline of the Medicaid limit. I promise when we get it we will smile with happiness and not with wrath or snottiness.

    Some people know how to be appreciative. SOme people only know how to ply the system. Everyone who gets Medicaid is not an ungrateful wench, please believe it.
  4. by   grannynurse FNP student
    Quote from P_RN
    I'm totally disabled and get Medicare. It's no walk in the park I will tell you hthat. The looks I get from drugstore clerks, office assistants, hospital clerks shrivel the soul. When you get SSDI you have no choice to get Medicare. If you don;'t then they treat your bill as if you have it and you are responsible for the difference plus what Medicare would have paid.

    I don't qualify for Medicaid, but I'm trying to get it for care for my Mama. I can't handle her physically and she is draining me emotionally. At $900 mo SS bbefore the $88 for Medicare she makes just borderline of the Medicaid limit. I promise when we get it we will smile with happiness and not with wrath or snottiness.

    Some people know how to be appreciative. SOme people only know how to ply the system. Everyone who gets Medicaid is not an ungrateful wench, please believe it.

    I hope you qualify. I can't. Am trying hard to figure out which of the providers to choose for Medicare D. It is a mess to figure out. How about you?

    Grannynurse
  5. by   penguin2
    I
    Last edit by penguin2 on Aug 16, '06
  6. by   mercyteapot
    So far, no one has said anything to convince me that these cases they are citing are examples of fraud. There is no way these people would be able to qualify for Medicaid if they owned these vehicles of which are being spoken, so they're either in hawk to the lien holder (and what's wrong with these lenders that they extend credit to people with such low incomes, I don't know, but that doesn't constitute fraud), or they're borrowing the cars. My Dad died several years before his time, solely because he was so opposed to the idea of applying for disability or Medicaid that he used every dime of his savings and became destitute. He would rather have died than to take money from the government. He wouldn't even tell us he didn't have money for his insulin. We had no idea. I hate to think that there is such a stigma attached to public assistance that someone else out there is going to lose a parent before their time, but apparently that is the case. The sad thing is that had he applied for this assistance, there are those of you out there who would have sneered at him and wondered why a man who looked so able bodied wasn't "contributing to the system". In reality, he contributed to the system every year of his life, but became self employed just a few years before he became ill. The Medicaid law is so complex that there is no way any lay person could understand it. I'm not even convinced that the administrators who are supposed to understand it have a good handle on all the subtleties. I have no doubt that there are cases where it is being abused, again because that's the way most every system works. I'm careful about applying that judgment to any particular individuals, though, because I have no way of knowing all the facts.
  7. by   Multicollinearity
    I sense from many of the posts here, that the anger is really about how much those on private insurance have to pay, rather than any actual Medicaid fraud. These are of course separate issues. If this is the case, perhaps some should consider if the problem is the system of healthcare financing in the US, rather than any real or perceived Medicaid fraud.

    We spend more total $$$s in the US to cover the lowest percent of citizens of any industrialized nation. The other industrialized nations spend less, cover everyone, and have better stats (infant mortality, life expectancy) to boot.

    I hesitate to bring this up, because it can appear like another issue. But I think it is really all part of the same pain as evidenced there in this thread.

    Also I have read comments on this thread about how 'they' should just purchase their own coverage. Health insurance is unlike any other product out there. If you have health problems, no matter how much money you are willing to pay, many times you cannot get any company to sell you coverage. I am talking about individual coverage, not employer coverage or HIPAA coverage.

    Example, because I have severe asthma I cannot get coverage for less than $1200 per month under HIPAA. Also, many employers are choosing to control their spiraling-out-of-control premiums by excluding from coverage pre-existing conditions for the first 12 months for those who did not have previous coverage. I spoke with a social worker the other day who said many of these folks are ending up on Medicaid, while working (poor) in order to get their meds and tx. Oh, and we are not blameless in the US as citizens. US healthcare financing largly doesn't work because so many people don't pay in premiums when they are healthy and able to pay premiums. It's called adverse selection. Meaning, healthy people skip paying and the sick and responsible pay their insurance premiums.

    Really, the only people left with good coverage (even though they gripe about the cost) are those employed by large employers, gov't, and retirees thru medicare.

    I was a health insurance broker for many years. I know that the system does not work in the US. Frankly, at this point, I wish every single person who qualifies for Medicaid would go get on it, and use it as they need it, appropriately. Only when the Federal and State budgets are in an epic budgetary crisis (worse than now) will we get anything like a universal solution.

    Let's remember, we are talking about people using the services for illness/pain. I know a woman who couldn't bear to apply for Medicaid. Pride. Stigma. She was unemployed and had back pain that she couldn't figure out. She kept trying to hold on and get a job with health insurance, despite being in pain. She died last year of cancer. Tumors on her spine. If she had gotten on Medicaid earlier and gotten treatment she possibly could have made it. Doesn't that put the occasional irritating Medicaid mooch in perspective?
    Last edit by Multicollinearity on Jan 3, '06
  8. by   grannynurse FNP student
    Quote from multicollinarity
    I sense from many of the posts here, that the anger is really about how much those on private insurance have to pay, rather than any actual Medicaid fraud. These are of course separate issues. If this is the case, perhaps some should consider if the problem is the system of healthcare financing in the US, rather than any real or perceived Medicaid fraud.

    We spend more total $$$s in the US to cover the least number of citizens of any industrialized nation. The other industrialized nations spend less, cover everyone, and have better stats (infant mortality, life expectancy) to boot.

    I hesitate to bring this up, because it can appear like another issue. But I think it is really all part of the same pain as evidenced there in this thread.

    Also I have read comments on this thread about how 'they' should just purchase their own coverage. Health insurance is unlike any other product out there. If you have health problems, no matter how much money you are willing to pay, many times you cannot get any company to sell you coverage. I am talking about individual coverage, not employer coverage or HIPAA coverage.

    Example, because I have severe asthma I cannot get coverage for less than $1200 per month under HIPAA. Also, many employers are choosing to control their spiraling-out-of-control premiums by excluding from coverage pre-existing conditions for the first 12 months for those who did not have previous coverage. I spoke with a social worker the other day who said many of these folks are ending up on Medicaid, while working (poor) in order to get their meds and tx. Oh, and we are not blameless in the US as citizens. US healthcare financing largly doesn't work because so many people don't pay in premiums when they are healthy and able to pay premiums. It's called adverse selection. Meaning, healthy people skip paying and the sick and responsible pay their insurance premiums.

    Really, the only people left with good coverage (even though they gripe about the cost) are those employed by large employers, gov't, and retirees thru medicare.

    I was a health insurance broker for many years. I know that the system does not work in the US. Frankly, at this point, I wish every single person who qualifies for Medicaid would go get on it, and use it as they need it, appropriately. Only when the Federal and State budgets are in an epic budgetary crisis (worse than now) will we get anything like a universal solution.

    Let's remember, we are talking about people using the services for illness/pain. I know a woman who couldn't bear to apply for Medicaid. Pride. Stigma. She was unemployed and had back pain that she couldn't figure out. She kept trying to hold on and get a job with health insurance, despite being in pain. She died last year of cancer. Tumors on her spine. If she had gotten on Medicaid earlier and gotten treatment she possibly could have made it. Doesn't that put the occasional irritating Medicaid mooch in perspective?
    I have worked in fraud and abuse investigation, for the NYSDOH. I have also worked in public home health, as well as a rehab nurse/case manager for WC/personal liability. I have seen less then 10 out right fraud cases in WC, none in liability, none in home health. I have listened to some of my relatives offer the same claims of seeing someone receive medicaid or welfare that they feel should not but they do nothing about it but complain. Regardless of what some believe, in this country, we are the only industrialized western county where health care is not a right. Where health care cost spiral up and up every year. Where more and more of our middle income families spend more for less coverage. Where medication cost continue to go out of control. Where some deny themselves health care and medication from some warped sense of non-entitlement, who then die.

    Until such time this country learns that health care is a rught, we will continue along the same pathetic road we are currently on.

    Grannynurse
  9. by   stephera
    Yeah, by people who do not really even need it!! A mother can go in and get afdc and automatically get medicaid for the whole family while some do not even need it!! I am a diabetic over here with no assistance with DR's or meds and all those people out there getting medicaid to use for what - because they have a simple cold!!! It p's me off to no extent!!!!!!!!!! Oh, here in Texas an adult can only get medicaid if they receive cash assistance(AFDC)!!!!!!!!!!!!
    Steph
    Last edit by stephera on Jan 3, '06
  10. by   mercyteapot
    There is no more AFDC, it is now called TANF- Temporary Assistance for Needy Families. You can't have it for life any more. I agree with whoever it was that said that this all sounds more like it is about anger- either at what is being paid for private insurance premiums, or at not qualifying for public assistance when others do. However, just because things aren't fair doesn't mean someone is committing fraud. The working poor (and in many cases, the middle class, too) should be entitled to the same health care that Medicaid recipients receive. The government should stop discouraging marriage by incentivizing staying poor and unwed. No doubt about those points. Claiming that beneficiaries of the system are committing fraud is blaming the wrong party, IMHO. The big problem is the system itself.
  11. by   StuNurseUP
    I was married, had a good job, my own health insurance , a 1 1/2 year old boy, and I was pregnant. Husband became very abusive....had to flee the state and hide out until the custody hearing. I went on assistance and entered the address confidentiality program. The social worker helping me saw my wedding ring and made nasty comments about me having something like that while bieng on assistance. I kept my wedding ring b/c people tend to give my crappy looks for bieng pregnant without having one on. Dammed if you do dammed if you don't. There is no way to make everyone happy...some people get a high from bieng judgemental. I am now in nursing school but my kids still have state insurance. I can't afford it and the deadbeat ex isn't paying like he should. I cannot wait to get of state aid. I need it but the hell that people put you through makes it almost unbearable:dirty looks, s******ing, how can you afford that comments- it takes away your dignity.
  12. by   LoriAlabamaRN
    Quote from BSNDec06
    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.
    You and I have a lot in common.
  13. by   CyndieRN2007
    Quote from grannynurse FNP student
    I would really like to see all these people who are receiving Medicaid fraudently, really I would.

    To be honest with everyone, I am sick and tired of a few complaining about another few and acting like they were the majority. If you feel some one is receiving Medicare, Medicaid, food stamps, public assistance fraudently YOU HAVE THE RESPONSIBILITY TO REPORT IT TO THE APPROPRIATE AUTHORITY. Thar is medicare, medicaid, your public assistance office, your state attorney general. And you don't have to give your name. All you need is the name and address of the suspected person or persons. You can even send a letter in. And while you are at it, take a look at the facility you work for and their /mistakes'. It is funny how they keep making the same one over and over and over-------

    Grannynurse
    There are many people who scam to get assistance. To be honest, I have seen it a lot. I've seen alot of people cheat, and a lot of people get caught and have to pay it all back. What hurts me though is the kids, its not their fault. When the foodstamps get cut off because of dishonesty from the parents, they can't eat as good and they wonder why.

    Many people (esp with kids) need foodstamps and cant get it because of some technicality{sp}, so they scam. Its not right, but it happens. People who receive home medical care are most likely getting assistance on the "legit". I'm sure people that are scamming for public assistance dont have medical personnel coming to their homes everyday where it becomes evident that they receiving assistance fradulently, for example, someone else living there, or not living there.

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