Medicaid Fraud

Medicaid fraud is a serious offence. If you find yourself as a victim of such a crime, you should make the effort to report to the authorities immediately. This is the situation where you find that you have been charged more than is supposed to indicate in your hospital bill. One reason could be that you did not get the drugs or the services that you are being asked to pay for. It is a common happening where unscrupulous practitioners will ask for payment of treatment that never took place. This means that you have to be very keen and always take your time to evaluate the medical bills that you receive. Here are some ideas on how you can report such a problem to the authorities:

1. You get to know the kind of Medicaid fraud that has taken place and understand the dimensions as well as the circumstances under which it took place. It can be an issue between you and a doctor who is claiming to have offered you the services or medical equipment. The actual bill can be inflated to a given level. In some circumstances, the doctor might have carried out a medical procedure that you did not need and gone ahead to claim the money.

2. You should check out how much money has been involved in the fraud. This means that you look in to the statements and invoices that show the charges that you have been billed. You should mark out the figures that you can explain in the statement and they will be followed up to establish their authenticity. You should have clear explanation about the treatment or incident under which the amount falls. If you can recall it, the better. This makes it very important to scan through your bills and medical invoices to ensure that you are not getting bills that you did not benefit from.

3. The next step would definitely be to talk to the institution that is involved. You should get all the relevant details including the name and other details about the doctor who treated or who is alleging that you received the medical services or equipment. The physical address is very vital as well as other information that can make it easy to get in touch with the medic. If you are not able to get these details, you can still go ahead and report any Medicaid fraud. You will be assisted to carry out the investigation.

4. You should write a letter to Medicaid. This will mark the beginning of the process of the investigation to unveil the fraud. You have to give all your details and the relevant information about your Medicaid cover. You should not live out the fine details such as the dates and times when the incidents are said to have taken place. In fact, you can get the copies of the statements and attach them together. This will ensure that the people who are involved in the Medicaid fraud will be brought to book with sufficient evidence.

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How to Apply for Medicaid

Getting a medical cover is very vital. It is one of the easiest ways to ensure that all you medical bills are paid without any stress. There are many providers in the market and Medicaid is one of them. If you want to join this company, all you have to do is make an effort to learn how to apply for Medicaid. It is relatively simple and it does not take you too long. All you have to is to go to one of the offices or even carry it out online. There are a few stages and procedure that are required of you. To begin with, you have to show that you really need that kind of financial assistance. There must be something to prove that you need the assistance as this health cover is for the people who are not financially stable. Here are some points that you should make note of when learning how to apply for Medicaid:

1. The nature of the health cover: You should know that this cover is for low income earners. This is a stipulation by the government and there are rules that can offer or deny you the qualification. You should know that that it is run by the government to take care of the persons who cannot afford the regular medical covers. If you have a good job or a regular income, this is not the place for you.

2. You should know what you are entitled to. If you have receiving some social funded services in the past, you most likely qualify for the Medicaid. All you have to do is to work in to one of the office or even write a letter to them. Today, the government has some stringent measures that are used to determine the person who qualifies.

3. You should go to the nearest social services office. This is the right place to know how to apply for Medicaid. You have to bear in mind that you are getting the help because you are not capable. The forms require you to offer many details about you financial ability. You have to bring some papers like the driving license as well as the social security card. You will be asked some questions on a one to one setting as well. The government wants to ensure that they helping a person who really need the health insurance. The banking papers are required as well.

4. If you find the process complex, you should not hesitate to ask for a qualified person who can assist you. There are some terms that you may not quite understand. You should bear in mind that you are required to offer the information as per the stipulation. If you made an error and declined to give the right information, this may not go well. In such circumstances where you will withhold crucial information, it might be misconstrued in a bad light. You can call the social workers to assist you from home in case you cannot make it to the offices.

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Medicaid Application Form

Medicaid is a federal and state program that provides medical cover to low income families, children, and adults with disabilities. It also provides nursing homecare cover to those who meet the requirements. Most Medicaid holders do not enjoy home care as most of the states have limited the provision, with New York being the only state where all Medicaid holders enjoy home care provisions. Once you qualify for Medicaid, all that you are required to do is to fill out a Medicaid application form, submit it and await confirmation.

There are different application forms available. There is a specific application form available for families as well as children who want to get Medicaid. All children below 21 years and grownups who have children under their care are eligible for Medicaid even without disabilities. All you are needed to do is to make a list of all persons that are in need of Medicaid.

There are certain requirements set by state laws regarding Medicaid application. The requirements for Medicaid application vary from one state to another, and this is so because states are required to: establish their own requirements for eligibility, set their own typed of services, time frame, and cost of services offered, set the rates of payments and manage their own Medicaid programs. But though this is so, most states have similar application requirements for those willing to fill out a Medicaid application form.

• You will need to identify yourself as a basic requirement. One is required to submit a filled out application form to the Department of Family And Children Services through mail, in person or through e-mail.

• Another basic requirement is age. You should be either a child or be above 65 years, and be an American. You will need to prove where you reside, provide your Social Security number, and prove that you receive other benefits like cash, housing or food assistance.

• If you are applying for a cover that has to do with disabilities, then you will be required to prove your disability, as well as meet all income requirements.

• Relevant documentation will be required. Documents such as birth certificates, government benefits documentation, bank statements, ID card and receipts from rent will be needed.

• A Medicaid application form will take approximately 24 hours to process, and the date of submission is taken as the day of application if you choose to apply through phone, personally or through mail. If you use postal mail, the application date is taken to be the date that the application is received.

• The application takes approximately 10 days for general applications, while applications for disabled persons takes 60 days, and that of pregnant women, infants and the aged (over 65 yrs) the time frame for consideration is 45 days.

When completing a Medicaid application form, you need to be extra careful. Always carry your basic family information such as names, address and phone number, dates of birth and financial details about your family by writing them down lest you forget.

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Center for Medicare and Medicaid Services

Medicare and Medicaid were first proposed in 1945 and signed into law in 1965. Since then, major changes have been made to CMS. The Center for Medicare and Medicaid Services is a consortium based on the Agency’s major line of business namely: Medicare financial management, Medicare health plans, Medicaid and child health, Medicare fee for service operations among others.
There are four main consortium’s namely:

1. The health care operations consortium: Functions as the main stop for all businesses done with health care firms, Medicare Advantage Plans, Medicare prescription plans among others. It also operates as the main stop for all agency relations done with employers, employees, retired persons and any other person working on their behalf concerning the Agency’s policies and services and any matter relating to sponsored drug cover. It also serves as the main base for any connections with beneficiaries and their families, care takers, health care providers and any person working on behalf of the beneficiaries regarding educating the beneficiaries on making sound decisions relating to the program.

2. Financial management & fee for service operations: Functions as the centre for all businesses relating to the Office of Financial Management. Takes charge of all field operations relating to Medicare Secondary Payer. It serves as the main station for all the Agency’s operations between health care providers and fee for service contractors in regards to matters concerning some areas of the fee for service policies. It acts as the main center for comments relating fee for service legislation to find out its impact.

3. The Medicaid and Children’s health operations Consortium: It functions as the main center for all Center for Medicare and Medicaid Services activities in regards to Medicaid and children’s health Insurance Program and operations. This consortium is responsible for providing overall supervision and technical aid to the state’s CHIP. It is mainly responsible for putting into place the National Medicaid program as well as supportive procedures to ensure an effective program is administered, and recipient protection. This consortium partners with corresponding states in the evaluation of the success of agencies in their duties as well as promoting quality operations. It is also responsible for the implementation, interpretation and application of various laws and policies that are directly involved in the governance of the financial procedure, as well as the management of the Medicaid program. The consortium is responsible for the initiation and implementation of special regional projects. It directs and monitors the integrity and efforts of states in running activities.

4. Quality improvement and survey & certification operations consortium: Its main functions are: it is the centre for all medical and clinical issues and it is responsible for the management of quality activities with other organizations. It is responsible for the supervision of Medicare and Medicaid to ensure quality and success are attained. It employs quality practices and methods for quality advancement. It ensures that all activities relating to the Agency such as payment policies, provider plans and beneficiary awareness as well as any technical assistance are effectively incorporated.

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