©2020 by Prefix Health Technologies

Search
  • Steve Grant

Is It Fraud Though?

https://thehayride.com/2019/09/study-more-than-half-a-million-enrolled-in-medicaid-in-nine-states-are-ineligible/


A recent National Bureau of Economic Research paper suggests that there are many people covered by Medicaid who are actually ineligible. This is a complicated question which we believe is nearly unmeasurable given the current state of Medicaid technology. This is not a new question - there are many reports of overpayment by the Medicaid system.


But the big fraud graphic on the article above suggests bad people where the truth is probably much more about bad systems. Determining medicaid eligibility is hard to do correctly as families and their incomes are dynamic. But this is very different from, for example, providers that purposely submit claims for services that were never delivered. This is fraud. The difference counts as a responsible approach to a solution requires the proper identification of a the problem. Both issues are important as their are tremendous amounts of taxpayer dollars at stake. But confusing cause never helps.

1 view