Thread: U.S. Suit Says New York City Overbilled Medicaid

U.S. Suit Says New York City Overbilled Medicaid

By ANEMONA HARTOCOLLIS
Published: January 11, 2011

[b]The federal government has accused New York City of overbilling Medicaid by “at least tens of millions of dollarsâ€

Why would a 75 or 82 year old woman be on MediCAID? She should have been on MediCARE, since it's for senior citizens. Perhaps they where not eligible for MediCARE? Oh I don't know why, maybe they were illegal aliens? Seems to me NYC played fast and loose with this and should be called on it.

Who is Eligible for Medicare?


Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you aren’t yet 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).
http://www.medicare.gov/MedicareEligibi ... ent#TabTop

About 2 years ago my mother in law had a medical emergency that required a visit to the ER. She was admitted over night and released the next day with special instructions for further medical procedures that she would have to apply herself.

The insurance she has had limits so we were told a home healthcare nurse would visit for 2hrs twice a day for the first 3 days and there would be one final 7th visit on the 4th day to teach us those procedures.

The first nurse to visit took one look at her chart and disgustedly told us she knew an IA with the same medical problem would be required to have a visiting nurse for 24/7 for at least 2 weeks. She also said an IA would have been in the hospital for probably 3 days for observation.

The nurse that told us this was a Jamaican who got her citizenship legally. She was as upset at the gaming of the system perpetrated by IAs as I was.

Americans receive limited benefits according to their insurance. IAs receive Cadillac benefits according to govt. mandates.

Who is eligible for Medicaid?

Medicaid is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills.

Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.

Medicaid is available only to people with limited income. You must meet certain requirements in order to be eligible for Medicaid. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co payment) for some medical services. (For more information, download "Medicaid At-A-Glance 2005" from the bottom of the page.)

To learn about the Medicaid program in your state see Related Links Inside CMS at the bottom of the page.

Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.

Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents). Eligibility for children is based on the child's status, not the parent's. Also, if someone else's child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child.

In general, you should apply for Medicaid if your income is limited and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)

For specific information about enrolling in Medicaid, eligibility, coverage and services for your State, please contact your local Medicaid office. You can view your State's Medicaid Office contact information by visiting the Benefits.gov website (see the link on the CMS home page) or checking the contact information for State Medicaid offices (see the link on the CMS home page.)

Screening Tools

To help you see if you may be eligible for a variety of governmental programs, you may access the GovBenefits and BenefitsCheckUp websites. (See related links on the CMS home page.)

When Eligibility Starts

Coverage may start retroactive to any or all of the three months prior to application, if the individual would have been eligible during the retroactive period. Coverage generally stops at the end of the month in which a person's circumstances change. Most states have additional "state-only" programs to provide medical assistance for specified people with limited incomes and resources who do not qualify for the Medicaid program. No Federal funds are provided for state-only programs.

What is Not Covered

Medicaid does not provide medical assistance for all people with limited incomes and resources. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services for everyone. You must qualify for Medicaid. Low-income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. As noted earlier, categorically needy persons who are eligible for Medicaid may or may not also receive cash assistance from the Temporary Assistance for Needy Families (TANF) program or from the Supplemental Security Income (SSI) program. Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses.
http://www.cms.gov/medicaideligibility/

New York State Medicaid info.

What is Medicaid?Medicaid is a program for New Yorkers who can't afford to pay for medical care.

How do I know if I qualify for Medicaid?
You may be covered by Medicaid if:

•You have high medical bills.
•You receive Supplemental Security Income (SSI).
•You meet certain financial requirements.

How do I apply for Medicaid?You can apply for Medicaid in any one of the following ways:
Write, phone, or go to your local department of social services. You can also mail in an Access NY Health Care application to your local department of social services, or apply with the help of an enrollment facilitator.

In New York City, contact the Human Resources Administration by calling (718) 557-1399. Residents of the five boroughs of New York City may call toll free at 1-877-472-8411.

Residents of New York City can mail applications to the Human Resources Administration at:

Initial Eligibility Unit
HRA/Medical Assistance Program
P.O. Box 2798
New York, NY 10117-2273

Pregnant women and children can apply at many clinics and hospitals. Call your local department of social services to find out where you can apply.

If you are in a facility operated by the New York State Office of Mental Health, contact the Patient Resource Office.

If you are in a facility certified by the New York State Office for People With Developmental Disabilities, contact the Revenue Support Office.

What do I need to apply for Medicaid?

•Proof of age, like a birth certificate
•Proof of citizenship or alien status*
•Recent paycheck stubs (if you are working)
•Proof of your income from sources like Social Security, Supplemental Security Income (SSI), Veteran's Benefits (VA), retirement
•If you or anyone who lives with you is 65 years old or older, certified blind, or certified disabled, you need to give information on bank accounts, insurance policies and other resources
•Proof of where you live, like a rent receipt, landlord statement, mortgage statement, or envelope from mail you received recently
•Insurance benefit card or the policy (if you have any other health insurance)
•Medicare Benefit Card (the red, white and blue card)

*NOTE: Medicaid coverage is available, regardless of alien status, if you are pregnant or require treatment for an emergency medical condition. A doctor must certify that you are pregnant or had an emergency, and you must meet all other eligibility requirements.

http://www.health.state.ny.us/health_ca ... d/#qualify