Author Topic: Medicaid fraud  (Read 1600 times)

Offline petster

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Medicaid fraud
« on: December 01, 2019, 11:27:46 AM »
Might be whywe have a pharmacy on every block.  JH gets mentioned

New York state is grappling with a Medicaid shortfall in the billions of dollars. And one of the main reasons is improper enrollment.
Using annual information from the Census Bureau to assess the demographic make-up of Medicaid enrollees over time, researcher Aaron Yelowitz and I estimated that 2.3 million to 3.3 million Medicaid enrollees nationally make an income in excess of what is allowed.
This is of increasing importance given that ObamaCare massively expanded what was historically a welfare program for vulnerable populations like the disabled and low-income children and pregnant women — and tens of billions of taxpayer dollars are at stake.
Excluding traditional pathways onto Medicaid (such as through disability or pregnancy), Yelowitz and I concluded that the number of working-age New York state residents on Medicaid who have incomes above the eligibility threshold rose by more than 80 percent between 2012 and 2017. We estimated that between 337,000 and 433,000 working-age New York state residents with income above the allowed limit are improperly enrolled in Medicaid.
And nearly half of this improper enrollment is in New York City, with 30 percent in The Bronx and Queens, where a few neighborhoods have among the highest percentage of improper enrollees of anywhere in the country.
In The Bronx, particularly the Concourse, Highbridge and Mount Eden regions, we found that roughly 40 percent of all working-age adults with incomes exceeding income eligibility thresholds were enrolled in Medicaid in 2017. The next-worst area is in Queens — the Elmhurst/South Corona, Jackson Heights/North Corona and Sunnyside/Woodside regions. In those areas, there are likely tens of thousands of ineligible Medicaid enrollees.
ObamaCare deserves much of the blame for the surge in improper enrollment. It created a new category of Medicaid recipients — lower-income, able-bodied, working-age adults — with the federal government paying a much larger share of their expenses than for traditional enrollees.
From 2013 — the year before ObamaCare’s Medicaid expansion took effect — to 2018, there has been a surge of Medicaid payments out of compliance with legal criteria. In fact, improper Medicaid payments more than tripled.
While states bear some of the burden for improper spending, most of the bill is picked up by the federal government. We estimated that improper payments now exceed 20 percent of federal Medicaid expenditures, an amount above $75 billion each year.
As a result of ObamaCare’s more generous Medicaid funding, many states — including New York — have stopped properly assessing whether applicants are eligible before they enroll.
While the health-care industry, particularly insurance companies, has benefitted from ObamaCare’s windfall of federal cash and improper Medicaid enrollment, traditional enrollees face a harder time obtaining care — and taxpayers are stuck with an enormous tab.
The inspector general at the federal Department of Health and Human Services found substantial problems with New York state’s process for reviewing Medicaid eligibility. The state made large numbers of errors and did not always maintain documentation. An audit of the entire state’s program found 15 percent of applicants improperly enrolled. The size of the error was staggering, with the inspector general estimating that New York state improperly claimed more than $1.8 billion in a six-month period on behalf of more than 900,000 ineligible enrollees or people who were enrolled without having submitted all the proper documentation.
In order to get a handle on its budget crisis, New York should conduct targeted eligibility reviews in The Bronx and Queens. If the state doesn’t act, the federal government must step in and require eligibility reviews in these hot spots and others around the country. Some level of government owes it to taxpayers and to those who are truly eligible to get enrollment right.
Brian Blase, a special assistant to President Trump at the National Economic Council from 2017-19, is president of Blase Policy Strategies. Aaron Yelowitz is an economics professor at the University of Kentucky and a senior fellow at the Cato Institute. They are co-authors of the new Mercatus Center study, “The ACA’s Medicaid Expansion: A Review of Ineligible Enrollees and Improper Payments.”


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Offline dssjh

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Re: Medicaid fraud
« Reply #1 on: December 01, 2019, 11:35:01 AM »
cherry picking of statistics is common  on both far ends of the political spectrum, like this reprint of a far-right wing website's blog post (https://www.cato.org/research/medicare-medicaid)

. both of these gentlemen have been working overtime to eliminate Medicaid entirely, and  make drastic cuts to both Medicare and Social Security as well.

From the website of the Cato Institute, which funded this report:

"Despite their popularity with seniors, the disabled, the needy, and those who might otherwise have to care for them, Medicare and Medicaid have done enormous damage to the U.S. health care sector and to individual liberty. "



 

Offline itsit

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Re: Medicaid fraud
« Reply #2 on: December 01, 2019, 04:19:56 PM »
 I know of two situations where the people were advised to go on ObamaCare because of documented lower income. Neither is trying to cheat anyone but in both circumstances the people were not receiving a significant income at the time. One was working for himself in a startup taking no income and the other person had moved and was not employed at the time and had significant assets which she was not questioned about but brought up incredulously herself. Realistically, both would've gone without coverage if not for this opportunity.

Offline Jeffsayyes

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Re: Medicaid fraud
« Reply #3 on: December 02, 2019, 07:56:33 AM »
Health insurance seems really shady and incredibly wasteful. So much effort to sign people up for health care, free and not, and anybody who I've ever talked to there knows so little about everything involved. Really made me look down on politics and democrats bc it just reinforces the cliche of dems being wasteful and ineffective. 


Might be a mistake to bring politics into this...

Offline abcdefghijk

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Re: Medicaid fraud
« Reply #4 on: December 02, 2019, 09:03:35 AM »
It's the lack of transparency of health costs.

In other countries with universal health care, all costs are clearly designated. And the govt sets the recommended costs that they will reimburse. (The difference in cost, if there is one, is made up by the patient).

But this information is clearly available to everyone. Before a patient goes in for an operation/whatever.

Here's the example from the United Kingdom (The NHS is their universal health care)
https://improvement.nhs.uk/resources/reference-costs/

Here, it's run more like a USED CAR YARD where the cost of the used cars is hidden.

And the mission is to try and get as many $'s as you can from the (unwell and possibly desperate) buyer.










Offline JK resident

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Re: Medicaid fraud
« Reply #5 on: December 02, 2019, 12:44:45 PM »
New York spends more on Medicaid than California and Texas combined. There has to be tremendous waste and fraud. Medicaid costs will also explode when all the unlawfully present individuals are now enrolled. Also explosive growth are the seniors who are staying at nursing homes. Soon we will have hundreds of illegal seniors from poor countries filling up nursing homes. There are not enough beds for all the legal elderly that need this service. Many elderly also give away their money and houses to enter the nursing home. They plan this 10 years in advance. We need to raise more NYC taxes to cover the costs. 

Offline JK resident

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Re: Medicaid fraud
« Reply #6 on: December 04, 2019, 08:45:53 PM »

Offline JHHD

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Re: Medicaid fraud
« Reply #7 on: December 04, 2019, 09:17:17 PM »
Health care is a for-profit system in this country. That is the root of the problem.

Offline hum@njukebox1

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Re: Medicaid fraud
« Reply #8 on: December 04, 2019, 09:30:25 PM »
Exactly!

Offline Jeffsayyes

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Re: Medicaid fraud
« Reply #9 on: December 05, 2019, 08:11:25 AM »
We will need to raise taxes dramatically to cover the shortfall.

https://nypost.com/2019/12/03/state-assembly-speaker-says-raising-taxes-will-fix-new-yorks-budget-gap/?utm_campaign=iosapp&utm_source=pasteboard_app


funny.... then they will just waste that extra amount too. Just like the MTA, it isn't a lack of money that's the problem.

Offline Jhx

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Re: Medicaid fraud
« Reply #10 on: December 05, 2019, 09:21:12 AM »
You’re right, the problem isn’t about the money. It’s about the low lives that live in this neighborhood. The article said tens of thousands Are defrauding Medicaid that live in the Jackson Heights area. Talk about scraping the bottom of the barrel as far as residents in this neighborhood go. But yet they protest when they wanna open up a Starbucks and a target. Where are the protest for all these people fraudulently collecting  Medicaid costing the taxpayers millions of dollars?

Offline dssjh

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Re: Medicaid fraud
« Reply #11 on: December 05, 2019, 09:52:45 AM »
you hate this neighborhood. you hate your neighbors. you say this constantly. why do you stay at the "bottom of the barrel" among tens of thousands of people you hate?

Offline Jhx

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Re: Medicaid fraud
« Reply #12 on: December 05, 2019, 10:08:46 AM »
Somethings is wrong with you

Offline sl

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Re: Medicaid fraud
« Reply #13 on: December 05, 2019, 01:19:03 PM »
you hate this neighborhood. you hate your neighbors. you say this constantly. why do you stay at the "bottom of the barrel" among tens of thousands of people you hate?

No one hates the neighborhood, no one hates their neighbors. He is just stating facts.

Offline dssjh

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Re: Medicaid fraud
« Reply #14 on: December 05, 2019, 02:00:38 PM »
how would you know, since you live elsewhere, by your own account?

Jackson Heights Life

Re: Medicaid fraud
« Reply #14 on: December 05, 2019, 02:00:38 PM »