angelburst29
The Living Force
I'm not sure if this article belongs here but it's about Medicaid "fraud".
I'm on Medicare and Medicaid Health Insurance, due to - lower income bracket and services are at a bare minimum. Just to get a simple blood test and depending on what the Doctor ordered, can be a problem, if extra testing is needed. There's the standard health screening (temp, pressure including visit) and any other testing is scrutinized by the Health Insurance provider, which can take up to a week or more, for approval in a non-threatening setting. In some cases, testing is modified. Instead of a suggested MRI - X-rays or muscle testing by a Neurologist will be ordered - to reduce cost. From the initial Doctor's visit, approval of testing or alternate, to setting up appointments and getting testing done, could entail 3-4 weeks and another week or so for results - before another visit to the Doctor can be set up. Prescriptions are another problem if the Doctor prescribes a brand name. The Pharmacy will try to match a "generic" as a substitute and if none exist, a call is placed to the Doctor's Office and another variation is ordered. In the end, you have health coverage but in principle, it does little to help in a real medical emergency. If Medicaid doesn't cover "the full testing" ordered by the Doctor, his Staff will suggest a visit to the local Hospital "Billing Dept." to set up a payment plan - for your out-of-pocket expenses.
My experiences with Medicare and Medicaid, in the last 5-6 years, have me to the point, I have to weight my options - if I can financially afford to go to the Doctor's?
Now and then, I read cases on Medicaid fraud in the news. This one tipped the scales! They pay a small "fine" which probably doesn't even cover a percentage of the full amount extracted in the fraud and no one is held accountable or goes to jail? If I miss a payment, by a few days pass the due date, the "Hospital's Billing Dept." contacts me with threatening phone calls and mail notifications - that I can be fined or imprisoned - due to not receiving my Fifty-three dollars payment on time! They offer - no grace period - in the event, a SS Check is late in the mail. Thank Gawd, it only happened "once" and I finally paid off the Bill.
NY Jewish charity admits to Medicaid fraud, agrees to pay $47M
_http://www.jta.org/2016/01/21/news-opinion/united-states/ny-jewish-charity-admits-to-medicaid-fraud-agrees-to-pay-47m
January 21, 2016 - NEW YORK (JTA) — A Jewish health care charity accused of Medicaid fraud has agreed to repay $47 million to the U.S. and New York state governments.
CenterLight Healthcare, formerly called Beth Abraham Family of Health Services, admitted in a settlement to having over 1,000 ineligible members in its Medicaid-sponsored long-term care plan, the Forward reported Thursday.
CenterLight is a member of UJA-Federation of New York’s network of agencies and received $84,000 from the federation in the current fiscal year, according to the Forward. UJA-Federation and CenterLight declined to comment on the settlement.
According to the Forward, CenterLight’s auditor, Loeb & Troper, including FEGS, which filed for bankruptcy last year. In statements issued by New York State Attorney General Eric Schneiderman and U.S. Attorney Preet Bharara, CenterLight acknowledged in the settlement that 1,241 people referred to its Medicaid plan were either ineligible when they enrolled or were not removed after they became ineligible.
I'm on Medicare and Medicaid Health Insurance, due to - lower income bracket and services are at a bare minimum. Just to get a simple blood test and depending on what the Doctor ordered, can be a problem, if extra testing is needed. There's the standard health screening (temp, pressure including visit) and any other testing is scrutinized by the Health Insurance provider, which can take up to a week or more, for approval in a non-threatening setting. In some cases, testing is modified. Instead of a suggested MRI - X-rays or muscle testing by a Neurologist will be ordered - to reduce cost. From the initial Doctor's visit, approval of testing or alternate, to setting up appointments and getting testing done, could entail 3-4 weeks and another week or so for results - before another visit to the Doctor can be set up. Prescriptions are another problem if the Doctor prescribes a brand name. The Pharmacy will try to match a "generic" as a substitute and if none exist, a call is placed to the Doctor's Office and another variation is ordered. In the end, you have health coverage but in principle, it does little to help in a real medical emergency. If Medicaid doesn't cover "the full testing" ordered by the Doctor, his Staff will suggest a visit to the local Hospital "Billing Dept." to set up a payment plan - for your out-of-pocket expenses.
My experiences with Medicare and Medicaid, in the last 5-6 years, have me to the point, I have to weight my options - if I can financially afford to go to the Doctor's?
Now and then, I read cases on Medicaid fraud in the news. This one tipped the scales! They pay a small "fine" which probably doesn't even cover a percentage of the full amount extracted in the fraud and no one is held accountable or goes to jail? If I miss a payment, by a few days pass the due date, the "Hospital's Billing Dept." contacts me with threatening phone calls and mail notifications - that I can be fined or imprisoned - due to not receiving my Fifty-three dollars payment on time! They offer - no grace period - in the event, a SS Check is late in the mail. Thank Gawd, it only happened "once" and I finally paid off the Bill.
NY Jewish charity admits to Medicaid fraud, agrees to pay $47M
_http://www.jta.org/2016/01/21/news-opinion/united-states/ny-jewish-charity-admits-to-medicaid-fraud-agrees-to-pay-47m
January 21, 2016 - NEW YORK (JTA) — A Jewish health care charity accused of Medicaid fraud has agreed to repay $47 million to the U.S. and New York state governments.
CenterLight Healthcare, formerly called Beth Abraham Family of Health Services, admitted in a settlement to having over 1,000 ineligible members in its Medicaid-sponsored long-term care plan, the Forward reported Thursday.
CenterLight is a member of UJA-Federation of New York’s network of agencies and received $84,000 from the federation in the current fiscal year, according to the Forward. UJA-Federation and CenterLight declined to comment on the settlement.
According to the Forward, CenterLight’s auditor, Loeb & Troper, including FEGS, which filed for bankruptcy last year. In statements issued by New York State Attorney General Eric Schneiderman and U.S. Attorney Preet Bharara, CenterLight acknowledged in the settlement that 1,241 people referred to its Medicaid plan were either ineligible when they enrolled or were not removed after they became ineligible.