Medicaid. Is it being abused?

pannie · Feb 25, 2006

I've waded through this thread and it seems pretty clear. Those who have/are receiving benefits (and those working in the bureaucracy of providing said benefits) are very in favor of medicaid. Those of us that haven't, are appalled.

Kind of reminds me of the VA treating all those PTSD's after Vietnam and so many hadn't ever even left the USA. Did it stop the fraud then? No, because VA applies for money based on numbers. They had no interest in actually verifying. That's a problem with any program. It's way too tempting to perpetuate the need to justify your job.

I'm still scratching my head over paying in for 10 years; receiving benefits for 18 yr (if you're still 60 ) and thinking you're still flying on YOUR dollar. Especially receiving $1300 a month.

BTW, I do go out and volunteer. It ends up being about

6 hours, 5 days a week. But then there's always training sessions that are usually held on weekends, too. I volunteer with the elderly 3 x a week for 5 hours. I'm a court appointed special advocate and help provide special things for our wounded warriors. I'll give someone the shirt off my back but resent the heck out of not having a choice in what I support. And no, we don't deduct any of the expenses of me doing this.

Social security was never intended to be a complete retirement plan. It was supposed to be voluntary, not more than 1% and the benefits never be taxed. How's that working for us? Now, all those promises are broken and a completely new program comes in - MEDICAID.

Again, we have no problem whatsoever giving and giving. It's not having a choice in WHAT we give, WHEN we give, HOW MUCH we give, that gets to us.

Teeituptom, what politician would get elected telling the whole truth and nothing but the truth? Is there such a thing BTW? You see the division on this board.......

grannynurse FNP student · Feb 25, 2006

I've waded through this thread and it seems pretty clear. Those who have/are receiving benefits (and those working in the bureaucracy of providing said benefits) are very in favor of medicaid. Those of us that haven't, are appalled.
Kind of reminds me of the VA treating all those PTSD's after Vietnam and so many hadn't ever even left the USA. Did it stop the fraud then? No, because VA applies for money based on numbers. They had no interest in actually verifying. That's a problem with any program. It's way too tempting to perpetuate the need to justify your job.
I'm still scratching my head over paying in for 10 years; receiving benefits for 18 yr (if you're still 60 ) and thinking you're still flying on YOUR dollar. Especially receiving $1300 a month.
BTW, I do go out and volunteer. It ends up being about
6 hours, 5 days a week. But then there's always training sessions that are usually held on weekends, too. I volunteer with the elderly 3 x a week for 5 hours. I'm a court appointed special advocate and help provide special things for our wounded warriors. I'll give someone the shirt off my back but resent the heck out of not having a choice in what I support. And no, we don't deduct any of the expenses of me doing this.
Social security was never intended to be a complete retirement plan. It was supposed to be voluntary, not more than 1% and the benefits never be taxed. How's that working for us? Now, all those promises are broken and a completely new program comes in - MEDICAID.
Again, we have no problem whatsoever giving and giving. It's not having a choice in WHAT we give, WHEN we give, HOW MUCH we give, that gets to us.
Teeituptom, what politician would get elected telling the whole truth and nothing but the truth? Is there such a thing BTW? You see the division on this board.......

I worked for the New York State Department of Health as a fraud and abuse investigator for Medicaid. The majority of the fraud and abuse my partner and I investigated was not committed by the patients but the providers. I also worked with the Medicare investigators, investigating the providers and not the users of Medicare. The vast majority of abusers of both systems are not the users but the providers. They ripe off both systems for millions and millions of dollars, something a patient cannot ever hope to approach. I have said this over and over, if you see someone you suspect is riping off Medicaid or Medicare or food stamps or any government assistance program, YOU have the responsibility to report it to the authorities. YOU have the responsibility to call the Medicaid fraud and abuse investigative arm of your state. And the same goes for Medicare, food stamps or any other government program. If you really want to do something about this suspected fraud and abuse, open your mouths and report it. And keep reporting it. Or you can come to a message board and moan and groan about all those people who are riping off your system, and reap what you sow by your own inaction.

Grannynurse

pannie · Feb 25, 2006

I'm very aware, you've told us many times. It doesn't change ANYTHING. Providers and recipents are both doing wrong if they're abusing the system. One is no more wrong than the other one. GET THEM ALL! I can't believe you, as an investigator, didn't catch ANY abusers among recipents? I know investigators and their jobs are very different. Perhaps you were ASSIGNED to investigate providers ONLY? My friend Russell ONLY investigates recipents. We can safely say he hasn't bagged any providers. Does that mean there aren't providers abusing Medicare? OF COURSE NOT! It's just not his job, his area of expertise or training. I've never met any investigator who had such a wide scope of responsibility - recipents and providers. Perhaps this program has grown by leaps and bounds in the ensuing years since you worked there?

If I suspect abuse, I'd certainly report it. But I no longer work in a position where I'm exposed to Medicaid recipients except when working as a CASA volunteer. I report EVERYTHING to the judge in those cases.

My one vivid, vivid memory is of a "client" I was assisting insisting that she wanted MY chair! Yes, she wanted the darn chair I was sitting on. It belonged to a friend of mine (psychology professor), who'd passed away. I could always stand at the file cabinet to work, couldn't I? My words, not hers. Her actual words were "You can get another one. You can afford it." I WAS paying rent and deposit (her apartment burned) for another apartment. chit for new clothes, a gift card for $200 in groceries & toiletries and had replaced her medication and eye glasses. But she wanted the chair, too, even though a coalition of churches was providing furniture for her. The city didn't require any deposits for electricity or water. Quite a sense of entitlement, don't you think? I LOVE helping people. But my chair? This really isn't an unusual case, either. It sticks in my mind because OF THE CHAIR!

teeituptom, BSN, RN · Feb 25, 2006

I am not claiming to be the expert on health care financing, but a couple months ago I went to a meeting at work, where a 'head hancho administrator' was giving a speech.....he stated that the hospital loses money on medicaid patients, as well as patients covered by Child health plan plus.... a program for working class families here in colorado who make to much to qualify for medicaid. According to him, the health care institution is only reimbursed pennies on the dollar for what it costs to provide care. He then went into what all the implications of this were, with there being increased numbers of patients utilizing these payment sources.....

Yes they get paid pennies on the dollar, Ive heard that for so long. But if it werent for medicaid then these same hospital admin types would be bemoaning that they get absolutely nothing at al for their services. When pts without insurance come into the hospital for ER or whatever, the hospitals have people there now to get them to sign up for medicaid when they check in for treatment. Something is better than nothing.

irishnurse67 · Feb 25, 2006

I'm very aware, you've told us many times. It doesn't change ANYTHING. Providers and recipents are both doing wrong if they're abusing the system. One is no more wrong than the other one. GET THEM ALL! I can't believe you, as an investigator, didn't catch ANY abusers among recipents? I know investigators and their jobs are very different. Perhaps you were ASSIGNED to investigate providers ONLY? My friend Russell ONLY investigates recipents. We can safely say he hasn't bagged any providers. Does that mean there aren't providers abusing Medicare? OF COURSE NOT! It's just not his job, his area of expertise or training. I've never met any investigator who had such a wide scope of responsibility - recipents and providers. Perhaps this program has grown by leaps and bounds in the ensuing years since you worked there?
If I suspect abuse, I'd certainly report it. But I no longer work in a position where I'm exposed to Medicaid recipients except when working as a CASA volunteer. I report EVERYTHING to the judge in those cases.
My one vivid, vivid memory is of a "client" I was assisting insisting that she wanted MY chair! Yes, she wanted the darn chair I was sitting on. It belonged to a friend of mine (psychology professor), who'd passed away. I could always stand at the file cabinet to work, couldn't I? My words, not hers. Her actual words were "You can get another one. You can afford it." I WAS paying rent and deposit (her apartment burned) for another apartment. chit for new clothes, a gift card for $200 in groceries & toiletries and had replaced her medication and eye glasses. But she wanted the chair, too, even though a coalition of churches was providing furniture for her. The city didn't require any deposits for electricity or water. Quite a sense of entitlement, don't you think? I LOVE helping people. But my chair? This really isn't an unusual case, either. It sticks in my mind because OF THE CHAIR!

Even when it is reported that a Medicaid recipient boasts about how much he makes under the table, the welfare offiice really can't prove it. However, you've got to wonder about the intelligence of those who tell registration that they work construction, then say that they're on disability, then whip out their Medicaid card! I've seen this happen a lot. Unbelievable but true.

NurseJacqui · Feb 26, 2006

Oh please...it is defintely abused. Medicaid/Welfare/Food stamps, etc is supposed to be a TEMPORARY support system until one can get back on their feet. I know what it is like to be poor and to struggle and I DID something about it. When I see these young healthy people who don't even make an attempt to get a job mooching off the system,it makes me livid... especially since some of these people are in my own family! Sometimes circumstances arise which are beyond our control such as an unexpected health crisis or sudden job loss for example, in which case public assistance may be appropriate. However every attempt should be made to rise above those hardships. I admire people who are going to school or who try to get their health back on track if possible so they can rejoin the work force. There are ALWAYS special circumstances and no one is saying that EVERYONE abuses the system. But when I see an able bodied young healthy individual who is content to live off of the government I want to vomit. What ever happened to personal responsibilty and accountabilty? It would be nice if some of the dredges of society started pulling their weight. I think nowadays young people feel that the world owes them a living. Such an emphasis is placed on material possesions which are nice to have but priorities seem to be out of whack nowadays. There is a sense of entitlement present today that saddens me. Trust me I see it EVERYDAY. Its defintely a problem.

NurseJacqui · Feb 26, 2006

Well if a parent can't figure out how to give child Tylenol for fever or put a bandaid on skinned knees and rush them to ED instead maybe they shouldnt be parents. Accountabilty and responsibilty go a long way.

grannynurse FNP student · Feb 26, 2006

I'm very aware, you've told us many times. It doesn't change ANYTHING. Providers and recipents are both doing wrong if they're abusing the system. One is no more wrong than the other one. GET THEM ALL! I can't believe you, as an investigator, didn't catch ANY abusers among recipents? I know investigators and their jobs are very different. Perhaps you were ASSIGNED to investigate providers ONLY? My friend Russell ONLY investigates recipents. We can safely say he hasn't bagged any providers. Does that mean there aren't providers abusing Medicare? OF COURSE NOT! It's just not his job, his area of expertise or training. I've never met any investigator who had such a wide scope of responsibility - recipents and providers. Perhaps this program has grown by leaps and bounds in the ensuing years since you worked there?
If I suspect abuse, I'd certainly report it. But I no longer work in a position where I'm exposed to Medicaid recipients except when working as a CASA volunteer. I report EVERYTHING to the judge in those cases.
My one vivid, vivid memory is of a "client" I was assisting insisting that she wanted MY chair! Yes, she wanted the darn chair I was sitting on. It belonged to a friend of mine (psychology professor), who'd passed away. I could always stand at the file cabinet to work, couldn't I? My words, not hers. Her actual words were "You can get another one. You can afford it." I WAS paying rent and deposit (her apartment burned) for another apartment. chit for new clothes, a gift card for $200 in groceries & toiletries and had replaced her medication and eye glasses. But she wanted the chair, too, even though a coalition of churches was providing furniture for her. The city didn't require any deposits for electricity or water. Quite a sense of entitlement, don't you think? I LOVE helping people. But my chair? This really isn't an unusual case, either. It sticks in my mind because OF THE CHAIR!

Actually, I investigated abusers on both sides, providers and users. And my partner and I were unusual, as we worked directly under the Associate Commissioner for New York City, Department of Health, New York State. And our qualifications were not the norm, I was a nurse, he held his degree in public health administration. Granted, I held a BSN and a MS.

And the amount of money that obtain thru fraud was much greater when we invesigated providers then it was the users. I am not saying that there are not people who abuse the Medicaid system. There will always be some who take advantage of any system. I am happy for you that you have a sense of social responsibility, to report anyone you suspect of committing abuses. And I am equally sure that so are not those receiving Medicaid who do not abuse the system.

Grannynurse:balloons:

Email4KH · Jan 23, 2007

I just triaged a Medicaid frequent flier who rode the 911 express because he has a runny nose.

$400 ambulance service. $500 ED visit. I'm working my ass off; spending time away from my family to support this bullshit. I just sent an email to my county's Medicaid investigator reporting the situation and plan to continue to do so.

Half of the problem is that the hospitals corruptly turn a blind eye to recipient abuse for fear of loss of revenue.

I have plenty of suggestions to fix the problems, but many of them require balls our legislators don't have.

burn out · Jan 23, 2007

How about the young teenage girls who end up pregnant. Its almost an automatic qualification for full medicaid insurance, housing and food stamps. This can go on for generations.
Perhaps the government should tax those who have children out of wedlock as a burden to society. This may encourage teens to practice birth control. Those who are able to care for their children could receive a tax break if they show they have proper insurance, a home, and a full time job.
Is the system geared for the achievers or the irresponsible?

It must be nice to live in a perfect world. If you can tell the world how to keep teenage girl from getting pregnant I would certainly love to hear it. I have always cared for my children , provided the best I could and always have carried health insurance. However, when my 16 year old became pregnant our health insurance would pay for her to have the baby but would not cover the baby. Legally I am responsible for the mother but not the baby therefore the baby had to be put on medicaid and so did my daughter...not anything we wanted but the only answer. The relly sad part to the story is that I pay $320 a month for health insurance and she gets better coverage with medicaid than I did when she was a baby with insurance.

By the way not every out of wedlock baby ends up on medicaid. In fact I

know more married people with alot of kids on welfare than I know unmarried with just one.

morte, LPN, LVN · Jan 23, 2007

you either keep better control,, and/or provide birth control......and a fair number are NOT accidents, very much planned, with admittedly cockeyed teenage reasoning.....

irishnurse67 · Jan 23, 2007

I just triaged a Medicaid frequent flier who rode the 911 express because he has a runny nose.
$400 ambulance service. $500 ED visit. I'm working my ass off; spending time away from my family to support this bullshit. I just sent an email to my county's Medicaid investigator reporting the situation and plan to continue to do so.
Half of the problem is that the hospitals corruptly turn a blind eye to recipient abuse for fear of loss of revenue.
I have plenty of suggestions to fix the problems, but many of them require balls our legislators don't have.

I'd love to do that. However, I'm afraid it'd get traced back to me and I'd lose my job. I also don't think the welfare authorities would care. After all, if it's obvious to me that several of the medicaid patients could provide for themselves if they really wanted to, it must be obvious to them, too.