New River Mental Health Agency Being Investigated for Medicaid Fraud : How Clients Are Demanded to Manipulate the Medicaid System
There is an article in the recent Mountain XPress out of Asheville regarding the investigation and withholding of payments to a large mental health provider in western NC. See:
www.mountainx.com/article/35870/N.C.s-Medicaid-agency-launches-investigation-of-major-WNC-mental-health-provider
These old 'Community Support' companies continue to offer similiar supports but only for six months at a time for Medicaid clients. Thus, there is an intense flurry of activity which may or may not overlap very well w/ ongoing therapy (I am thinking of a client of mine w/ a severe mental health challenge that this was happening with recently) and then poof!....it disappears. It would be nice to know just how much help this is. I could tell that the additional resource of a person 'to call' was advantageous to the client when he was in crisis but basically the crisis was determined by whether he had his meds or not.
Relatedly, I received a call from a county DSS re: the client's ability to parent children yesterday and very clearly stated to the DSS social worker that the problem was not that the client could not parent children-----but that Medicaid drops off every six months (even though the client receives SSDI---but paid Social Security such a lot of money that client 'earns' just a bit too much to keep Medicaid in place)...thus Medicaid drops off every six months. That means that the client is then without all medication which may be necessary to support mental health functioning which include parenting children.
So, then the client manipulated the system----which is built to be manipulated in that you can take only two years of CURRENT medical bills and have them applied to a Medicaid deductible in order to reinstate Medicaid OR you can make a small payment on medical bills up to 7 years old and then DSS can then 'pull forward' those medical bills to create the deductible. There is no other way to get Medicaid reinstated. One has to meet the deductible if one's Social Security Disability check is more than about $1200/ month. Nevermind that there are 4 mouths to feed and take care of on that.
So, very tiresomely and using a lot of time and organization, the client has to make a minimal payment on an old unpaid medical bill, usually a long stint at a psychiatric hospital, which allows the local DSS to 'pull forward' the bill and apply it to the commonly $5,000-7,000 deductible----which then----months later----allows the Medicaid to be put back into place for-----YOU GUESSED IT-----six more months. Then we do the whole thing all over again and if necessary the client goes into the hospital w/ the specific agenda of cranking a bill so that Medicaid can be recreated again.
This is a great way to save Medicaid $$$, don't you think?
www.mountainx.com/article/35870/N.C.s-Medicaid-agency-launches-investigation-of-major-WNC-mental-health-provider
These old 'Community Support' companies continue to offer similiar supports but only for six months at a time for Medicaid clients. Thus, there is an intense flurry of activity which may or may not overlap very well w/ ongoing therapy (I am thinking of a client of mine w/ a severe mental health challenge that this was happening with recently) and then poof!....it disappears. It would be nice to know just how much help this is. I could tell that the additional resource of a person 'to call' was advantageous to the client when he was in crisis but basically the crisis was determined by whether he had his meds or not.
Relatedly, I received a call from a county DSS re: the client's ability to parent children yesterday and very clearly stated to the DSS social worker that the problem was not that the client could not parent children-----but that Medicaid drops off every six months (even though the client receives SSDI---but paid Social Security such a lot of money that client 'earns' just a bit too much to keep Medicaid in place)...thus Medicaid drops off every six months. That means that the client is then without all medication which may be necessary to support mental health functioning which include parenting children.
So, then the client manipulated the system----which is built to be manipulated in that you can take only two years of CURRENT medical bills and have them applied to a Medicaid deductible in order to reinstate Medicaid OR you can make a small payment on medical bills up to 7 years old and then DSS can then 'pull forward' those medical bills to create the deductible. There is no other way to get Medicaid reinstated. One has to meet the deductible if one's Social Security Disability check is more than about $1200/ month. Nevermind that there are 4 mouths to feed and take care of on that.
So, very tiresomely and using a lot of time and organization, the client has to make a minimal payment on an old unpaid medical bill, usually a long stint at a psychiatric hospital, which allows the local DSS to 'pull forward' the bill and apply it to the commonly $5,000-7,000 deductible----which then----months later----allows the Medicaid to be put back into place for-----YOU GUESSED IT-----six more months. Then we do the whole thing all over again and if necessary the client goes into the hospital w/ the specific agenda of cranking a bill so that Medicaid can be recreated again.
This is a great way to save Medicaid $$$, don't you think?
posted by Marsha V. Hammond, PhD at 9:52 AM
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