Fighting Against Medicaid Fraud
Medicaid was a scheme introduced in the 1960's as an addition to the social security legislation already in place to help needy people struggling on low incomes with their medical needs. Figures from the 2010 Kaiser Commission report show that over 15 million adults and 29 million children are insured under the scheme. Whilst it is clearly a good system that takes away the financial worries and implications associated with illness and hospitalization unfortunately it is a system that continues to open itself to abuse from unscrupulous companies and individuals cheating the government for their own gain. Consequently, the Government is constantly looking at ways to combat Medicaid fraud and abuse which costs them and the U.S. Taxpayer, billions of dollars each and every year.
Who provides Medicaid services?
Professionals that provide Medicaid services can either be health care facilities, individuals or a collective group of individuals. They include such people as doctors, nurses, dentists, licensed counsellors such as psychiatrists, medical supply companies, pharmacists, day care clinics, nursing homes and ambulance companies. What usually happens is that following the treatment of a Medicaid patient, the Medicaid program is billed for the relevant service or procedure. However, all too often unscrupulous companies or individuals seek to defraud the Government by reimbursement of more money than they are entitled to by means of:
- billing for services or supplies which were never provided
- billing for deceased patients
- billing for unnecessary treatments
- over billing for prolonged treatments which were in fact quite short
- billing the Medicare patient for treatment already covered under their insurance
- accepting bribes and kickbacks for referrals
Medicaid Fraud whistleblowers
The government doesn't have the time or resources to effectively clamp down on such a high level of fraud on its own and so it encourages individuals who have knowledge of an Medicaid fraud happening on their patch, to report their findings to the government in return for being awarded with a percentage of the recovered monies, usually somewhere between 10-30%. Since the amount of the fraud needs to be above $1 million dollars, it doesn't take a mathematician to work out that this is a highly attractive reward for doing the right thing. If you believe you have uncovered fraud within Medicaid then in the first instance you go with your findings to a knowledgeable attorney who will be able to help and advise you.
Why It Affects You
It's all too easy to shrug off Medicaid fraud reasoning that it doesn't affect you so why should you bother. In reality the hard facts are that the Government losses from Medicaid fraud have to be clawed back somewhere. This can result in reducing or withdrawing other important government services, which you may actually use, or it can mean increased rises in taxes. Either way it could leave you with fewer dollars in your wallet.
Introducing new technology – the fight goes on
Biometric ID Cards
Several states including New York, Texas and Georgia are now looking to implement biometric tools in an attempt to better identify Medicaid patients and are trialling programs. This would involve the use of palm scanners at clinics, pharmacies and hospitals to identify patients and cut down on medical identity theft. The cards would be used not only to authenticate patient visits but also prescription orders.
Predictive Modelling Computer Software
The Federal government has also taken the step of introducing computer software which can identify would be criminals before they receive a check from the taxpayer. The system is designed to collect and analyze information so that the government can spot potential fraud instead of analyzing one claim at a time. This technology is very similar to that which is already being used by telecommunication companies and banks to pin point fraud.
Clearly the Government is doing what they can and looking at new ways of curbing Medicaid fraud, but it still relies heavily on the due diligence of it's citizens to guard their medical information with as much care as they would their credit card, and, if they suspect something is just not right, to be brave enough to do the right thing.
