Medicaid Liability Report

Health care fraud and abuse are one of the U.S healthcare system biggest problems, which affect everyone either directly or indirectly. Billions of dollars have been lost due to health care fraud and abuse. With a number of losses, this can lead to increase in health care costs and potential increased of coverage.

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

or she can get low-cost health care at a nearby community health center. These health care

Those who utilize the Medicaid system range from low income families to the over 65 age group. Within this population is also those who are disabled due to physical or mental problems. This is among the sickliest of our American population. A paper based on a study in Oregon stated that “Medicaid significantly increased the probability of being diagnosed with diabetes, and being on diabetes medication as well as high blood pressure and high cholesterol.”(Baicker et al., 2013, p. 1715). Much of this is due to the struggle that the Medicaid beneficiary has

Medicaid is a medical assistance program for low-income Americans. It is funded partially by the federal government and partially by the state and local governments. The federal government requires that certain services be provided and sets specific eligibility requirements. Medicaid covers the following benefits required by the federal government; early and periodic screening, diagnosis, and treatment services, rural health clinic services, family planning services, SNF and home health services for persons over 21 years old, physicians’ services, laboratory and x-ray services, outpatient hospital care, and inpatient hospital care. Because Medicaid is also partially run by the state and local government individual states sometimes cover services

A patient must fall into one of the defined categories. Poverty is a requirement but it alone does not qualify.

Can Mr. Grant receive appropriate Medicare healthcare services at his home? If not, Why? Is Mr. Grant’s medical condition so severe that he can no longer have visitations to his home?

Immigrants that work should be allowed medical coverage when they are working for American agriculture or any American employment. They are all pulling their hours and time to boosting the American economy; therefore, it is only logical for them to have private coverage. I don’t agree that they should receive state Medicaid coverage and should be left for Americans. Medicaid should not available for them until they have been in the use over ten years.

A rural community is less than 50,000 but at least 2500 according to the united states census. He is low income so he is a Medicaid reciepant.This person has to make less than $11,670to be consider low income. To be eligible for medicade according to the textbook (wetle,austen 2012) one must be medically in need and at or below the poverty line. The local community healthcare facility does not accept Medicaid. The facility that does accept Medicaid is miles and about 40 minutes away. John Q only has no car. Also, the facility that accept Medicaid is has two week waitlist. These factors are all hindering his utilization of the healthcare system. He also will have to take off work because the MTF (medical treatment facility) does not have weekend or night appointments. I believe we must now assess how to make changes to these

Medicaid is government-sponsored for low income families with dependent children and people with disabilities under 65 years old. The coverage, as well as qualification for coverage may, vary by state. Individual can qualify based on family size and income level (Lewis, 2012). If a individual is denied Medicaid because of excess income, he or she may qualify for "Medicaid spend down," which pays medical bills over the excess amount (Lewis, 2012).

2 Certain persons in Florida are eligible for Medicaid. Please post a synopsis of this program. Be sure to include the following:

Medicaid offers health insurance benefits for individuals and families with low income (133% of the FPL). This includes low income: pregnant women, disabled, blind, and aged. Medicaid is administered by the states following federal guidance. Medicaid benefits vary from state to state. Eligibility requirements include being a U.S. citizen, and a resident in the state where benefits are received. In the case of immigrants, one must be in the U.S. for a minimum of five years. Both state and federal governments finance the program. Nursing home care is covered by Medicaid. Depending on the state, none or minimal copays and deductibles are associated with this program.

The most common way individuals defraud the Medicaid system is by providing false information on their application or renewal applications, such as not reporting employment or assets. This includes falsifying supporting documents and not being truthful about the number of people in a household. People who obtain medications or home health equipment under false pretenses, for example, by lying to a physician, so he or she can sell the medication or equipment, is also committing fraud.

HIPP grants are available to every ESRD patient in the U.S. who has a documented financial need based on their income to debt ratio for paying primary and/or secondary health insurance premiums and who would lose coverage without the assistance of AKF. Each year, this program helps ESRD patients from all 50 states, the District of Columbia, and the U.S. territories maintain access to all of the life-sustaining healthcare benefits covered by their insurance plans. HIPP grants are available to cover premiums for health insurance coverage under Medicare Part B, Medigap, Employer Group Health Plans, Consolidated Omnibus Budget Reconciliation Act (COBRA), and commercial insurance plans including those within the Marketplace exchanges and Medicaid where states require residents to pay premiums.

Although an individual may exceed Medicaid income levels in the state that they reside, he or she may still qualify for Medicaid due to ‘spend down rules’. This is due to the individual being classified as ‘medically needy’ (Medicare.gov, n.d.). “This process allows you to “spend down,” or subtract, your medical expenses from your income to become eligible for Medicaid. To be eligible as “medically needy,” your measurable resources also have to be under the resource amount allowed in your state” (Medicare.gov, n.d.)