“Massive” Medicaid Fraud in California

Posted by Tina

The Office of Inspector General in it’s oversight capacity investigated California’s Medicaid program during the period from October 1, 2014 through March 31, 2015 and found enrollment irregularities amounting to $1 billion in fraud. David Catron of The American Spectator explains:

California is indeed the Golden State where Medicaid is concerned. The HHS Office of Inspector General (OIG) has found that, by exploiting Obamacare’s expansion of the program, California has enrolled hundreds of thousands of ineligible adults in Medicaid. Consequently, the state has bilked the federal government out of more than $1 billion in funding to which the state was not entitled. Indeed, these figures probably understate the amount of money that California officials have fraudulently extracted from the taxpayers. The OIG sampled a mere six-month period, from October 1, 2014 through March 31, 2015, to arrive at its damning assessment.

Doctors who commit such fraud are jailed and forced to pay heavy fines. The article cites a case (Boston Globe): “A Brookline doctor has been sentenced to 11 months in jail and ordered to pay $9.3 million for running a Medicaid fraud scheme.”

Unless something is done to discover and prosecute those who participated in this fraud, once again, government officials will be given special consideration over the average citizen. But the prosepects are not great. Due to the way the Obamacare law is written, California officials have no incentive to be efficient and will likely avoid paying a price:

California officials made no serious effort to verify any of these data. The OIG sample revealed that 18 percent of enrollees are obviously ineligible, and that another 9 percent are probably ineligible. All of these enrollees failed one or more of the above-noted eligibility requirements. So, what’s the problem? Obamacare removed the incentive to be efficient. At present, 1 in 3 Californians are enrolled in Medicaid. And, as long as the “Affordable Care Act” remains in place, the federal government will pay a minimum of 90 percent of California’s Medicaid costs for new enrollees. (emphasis mine)

California, the Piggy Authoritarian State, also has no incentive to secure the border and cooperate with ICE when they can use illegals to defraud the federal government for extra cash. How many illegals are among those fraudulently receiving Medicaid because California bureaucrats purposely dismiss eligibility rules?

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15 Responses to “Massive” Medicaid Fraud in California

  1. J. Soden says:

    Anyone else wanna bet that the percentage of Illegals enrolled is pretty high?

    Interesting thing about Medicaid in Taxifornia – should you qualify, upon death, your estate will be attacked by Taxifornia for repayment.

    • Libby says:

      Oh, J … you can thank your RINOS for that one. And it’s Medicare, not Medicaid. BushCo slipped that into the Medicare Part D expansion, and it didn’t half cause a stir in the ol’ legal community.

      If you are on Medicaid, you have no estate … but be sure to hire an attorney to safeguard your lottery winnings or your insurance settlements, cause the Feds will come after them too.

      • J. Soden says:

        Wrong again, Libby. It’s Medicaid that goes after a estate as we found out when spouse’s mother was getting her affairs in order.

        And you can thank Obumblecare for the extra premiums taken outta your Social Security – that you earned – if you have more than what the goofernment thinks you should make for Medicare Parts A, B and D – even if you don’t use D at all!
        Another reason Obumblecare should be repealed!

        • Libby says:

          You are not thinking clearly about this at all. Medicare does not pay for nursing home care unless you purchase special coverage. Most people can’t afford this, and so they must turn to Medicaid, which pays medical expenses for people with no assets. The only way to get Medicaid coverage for your nursing home expenses is if, if and after, you have paid all you have out of pocket, and THEN they pick up the tab. It has ALWAYS been like this.

          It’s a jolt to everybody, J, or it was … 40 years ago, when we all realized that Granny’s end of life care was going to eat up every penny … but there it is. Where have you been?

    • Tina says:

      Obamacare made a deal with insurers that really paid off. LA Times, “Insurers make billions off Medicaid in California during Obamacare expansion”

      Medicaid is rarely associated with getting rich. The patients are poor, the budgets tight and payments to doctors often paltry.

      But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds that patient care is subpar.

      Your socialist dream, universal healthcare, will have the same effect only it will be “universal!” The rich get rich while the poor get sub par care and economically screwed.

    • Tina says:

      J you are exactly right despite Libby’s assertions:

      April 2005, U.S. Department of Health and Human Services

      Medicaid imposes stringent limits on income and assets of recipients, consistent with its mission to provide a health care safety net for the poor and for those whose personal resources are insufficient to pay the full cost of care. In order to fulfill this mission, Medicaid also recovers expenses paid on behalf of recipients from their estates under certain circumstances. Medicaid is the largest source of funds for institutional long-term care expenses. It pays nearly half of the total amount spent on nursing homes, followed, respectively, by out-of-pocket funds of long-term care consumers, Medicare, private long-term care insurance, and other public and private funding sources.1

      Unless they are among the minority who have long-term care insurance, individuals contemplating paying thousands of dollars out-of-pocket every month for long-term nursing home care face the possibility of exhausting all available assets and using up their lifetime savings before being able to qualify for Medicaid. Not surprisingly, a web search on “Medicaid estate planning” yields thousands of results offering advice on a variety of strategies to qualify for Medicaid while preserving assets and savings for heirs. … Since the beginning of the Medicaid program in 1965, states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child. Twelve states report having had an estate recovery program in effect before 1990 that was based on the original Medicaid law.

      It isn’t Bush that created the dysfunctional, unsustainable, and easily exploited programs and their rules. Bush’s Part D actually improved on the already broken RX portion of the law and inserted free market principles in the means. Ill-conceived bad laws cannot be patched to perfection, however, so the problems and the fraud will continue.

      More: NOLO, “How Medicaid Recovers the Cost of Long-Term Care From Your Estate After You Die”

      Elder law Answers, “Medicaid’s Power to Recoup Benefits Paid: Estate Recovery and Liens”:

      Under Medicaid law, following the death of the Medicaid recipient a state must attempt to recover from his or her estate whatever long-term care benefits it paid for the recipient’s care. States also have the option of recovering all Medicaid benefits from individuals over age 55, including costs for any medical care, not just long-term care benefits. However, no recovery can take place until the death of the recipient’s spouse, or as long as there is a child of the deceased who is under age 21 or who is blind or disabled.

      While states must attempt to recover funds from the Medicaid recipient’s probate estate, meaning property that is held in the beneficiary’s name only, they have the option of seeking recovery against property in which the recipient had an interest but which passes outside of probate (this is called “expanded” estate recovery). This includes jointly held assets, assets in a living trust, or life estates. Given the rules for Medicaid eligibility, the only probate property of substantial value that a Medicaid recipient is likely to own at death is his or her home.

      • Libby says:

        No, J is wrong. J is always wrong. Tina, your cites apply ONLY if Medicaid has had to pay out … BEFORE your “estate” is paid down. That is, if, somehow, you have avoided the state’s fiscal clutches (by, for instance, hiding, or even just failing to declare, assets), they’ll get the money in the end.

        Unusually, however, a patient or their family declares up front any fungible assets, and you pay down before you go on Medicaid.

        And ALL of this, as I said, pre-dates the ACA, so quit making erroneous comparisons.

      • J. Soden says:

        I never get upset at accusations or rants by Libby. I just consider the source . . . . . . .

  2. Libby says:

    Horsepucky. If the person is alive, and in the state, a person is eligible. What is the matter with you? I mean, what kind of savage state would you run? … if you were able, and thank god for the moment you are not!

    Tina, sick people do not get turned away from hospitals in this state, so we wind up paying, howsoever … federal, state, local … howsoever. I’ve explained all this to you before, several times. The ACA, and it’s provisions for Medicaid expansion, is our “foot in the door” to universal coverage. We are going to do it. Get over it.

    • Tina says:

      What in Gods name does treating sick people in hospitals have to do with the massive fraud being perpetrated on our already very generous system?

      The law was “exploited,” Libby. That’s a generous word for fraudulently cheating the system…usually for personal gain!

      You would have a fit if it could be proved that a right winger did this and you’d be going on and on about how this mean spirited exploitation hurts people who need and are eligible for the program.

      “The ACA, and it’s provisions for Medicaid expansion, is our “foot in the door” to universal coverage. ”

      So the real reason you object is your pet project. You don;t give a rats behind about the fraud and abuse.

      If you do prevail Libby you will die having been one of the authors of our complete demise. You will destroy our medical system and that will constitute the final blow for freedom and our republic. Without a thriving America the world would decline into a severely oppressed state. The New Dark Ages anyone?

      Lord you are short sighted and ignorant.

  3. Libby says:

    “What in Gods name does treating sick people in hospitals have to do with the massive fraud being perpetrated on our already very generous system?”

    The doctor was caught, charged, tried, imprisoned, and assessed reparations. What more do you want? … his head? As long as human beings continue to be the chief participants in society, this sort of thing is going to happen. To grouse about it is absurd.

    • Tina says:

      “The doctor was caught, charged, tried, imprisoned, and assessed reparations. What more do you want? … his head? ”

      Did you even read the article?

      The state of California did this!

      California has enrolled hundreds of thousands of ineligible adults in Medicaid. Consequently, the state has bilked the federal government out of more than $1 billion in funding to which the state was not entitled.

      Posting an article that includes information that California voters might want to know is not grousing.

      And a billion dollars is nothing to sneeze at, Libby. No sane person would or should casually tolerate such abuse of the taxpayer.

      • Libby says:

        Doesn’t this constitute changing the subject, Tina? … switching from the doctor’s convicted fraud to California’s purported fraud?

        And I wasn’t going to point this out, but the doctor practices in Boston. Your news purveyors just threw him in there, knowing you would not look closely. You really should look closely sometimes.

        Now, I already addressed this aspect of your post. In my view, there is no such thing as an “ineligible” adult. Further, these adults do get treatment (we are not barbarians), and it has to be paid for. Acknowledging their existence, considering them charitably, and signing them up for Medicaid is fiscally sound, morally grounded … and … what is your problem!

  4. Tina says:

    Geez, Libby, you are dense! The point of the article IS the government fraud. The doctor in the article was used as an example from the private sector who was “sentenced to 11 months in jail and ordered to pay $9.3 million” compared to state worker/s who will get away with bilking the system for $1 billion…double standard!

    So, NO, I haven’t changed the subject. If anyone has it is you.

    ” In my view, there is no such thing as an “ineligible” adult. ”

    Even if he’s a fiction? Or drives a Lamborghini? Or has a big pile of cash stashed off shore from his illicit drug trade?

    My problem is nut cases, like you, who imagine the world is filled with nice people and totally lacking in scoundrels and hucksters.

    You do understand the word fraud don’t you?

  5. Peggy says:

    Off topic FYI from Newt.

    Newt Gingrich: California may elect a Republican governor — Incredible as that sounds:

    “John Cox is doing something remarkable for a Republican. A recent survey indicates he is now within striking distance of being elected governor of the infamously liberal state in November.

    According to the Public Policy Institute of California, Cox (who I greatly respect and have worked with for years) has been gaining support since January and is now the second-place pick for governor among likely California primary voters. This puts him right behind the leading Democrat and represents a great potential for Cox to win the governorship seven months from now.

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