Tip Of The Iceberg Relating To Medicaid Fraud ?

[easilyscan 897]

Probably.

The indictment announced Tuesday alleged Happy House Behavioral Health LLC was paid the money for services that were either never provided or only partially completed and that there was billing for clients who were deceased and incarcerated.

Money laundering charges alleged Happy House Behavioral Health paid $5 million in July 2023 to a Hope of Life International Church, which later wired $2 million to an entity in Rwanda.

Maybe they should've named it happy hour behavioral health instead. Similar to what the Somali are doing to Minnesota.

https://apnews.com/article/arizona-medicaid-fraud-sober-living-native-americans-5dbebe90d8443230441f364ab880b9c2

[EternalShinyAndChrome 3,929]

This is absolutely disgusting and to think about how much money the left has been embezzling and scamming the US Taxpayers to fill their own pockets and other pet projects is simply the biggest scandal of our times.  EVERYONE involved needs lifetime jail time and we need to go after every one of these thieves and grifters.  Start with the Senate and Congress and then work your way down.

This has been going on for DECADES.  How many trillions have they taken?

[jbycho 666]

1 minute ago, EternalShinyAndChrome said:

This is absolutely disgusting and to think about how much money the left has been embezzling and scamming the US Taxpayers to fill their own pockets and other pet projects is simply the biggest scandal of our times.  EVERYONE involved needs lifetime jail time and we need to go after every one of these thieves and grifters.

This has been going on for DECADES.  How many trillions have they taken?

But, but...Trump. 

[easilyscan 897]

Saw a clip from a news conference with President Trump yesterday, think it was on Gutfeld. The first reporter immediately asked why Trump was going after Social Security & Medicare/Medicaid ?

He replied we're going after fraud in those programs, not looking to end any of them. Are these people genuinely stupid, or just asking questions like that to play down to the low information crowd ?

[jbycho 666]

2 minutes ago, easilyscan said:

Saw a clip from a news conference with President Trump yesterday, think it was on Gutfeld. The first reporter immediately asked why Trump was going after Social Security & Medicare/Medicaid ?

He replied we're going after fraud in those programs, not looking to end any of them. Are these people genuinely stupid, or just asking questions like that to play down to the low information crowd ?

Both. 

[easilyscan 897]

1 hour ago, EternalShinyAndChrome said:

This is absolutely disgusting and to think about how much money the left has been embezzling and scamming the US Taxpayers to fill their own pockets and other pet projects is simply the biggest scandal of our times.  EVERYONE involved needs lifetime jail time and we need to go after every one of these thieves and grifters.  Start with the Senate and Congress and then work your way down.

This has been going on for DECADES.  How many trillions have they taken?

To be honest, I'd rather not know. Just glad this administration is at least making an effort to go after it. 

[HellToupee 1,638]

From Tony Seruga

There are over a million people claiming Medicaid in multiple states. 

If you are okay with a single individual receiving Medicaid payments in 3-7 different states, you really are in the wrong country.

 

somehow I’m not surprised 

[Fnord 2,106]

21 hours ago, HellToupee said:

From Tony Seruga

There are over a million people claiming Medicaid in multiple states. 

If you are okay with a single individual receiving Medicaid payments in 3-7 different states, you really are in the wrong country.

 

somehow I’m not surprised 

Wondering how/where Tony got this info. Not sure it's true, but if it is it seems like there's a big problem with the verification process for eligibility. Do you have a link?

[easilyscan 897]

5 hours ago, Fnord said:

Wondering how/where Tony got this info. Not sure it's true, but if it is it seems like there's a big problem with the verification process for eligibility. Do you have a link?

Not millions, but enough to merit further investigation.

While it's technically impossible to be enrolled in Medicaid in multiple states simultaneously, bureaucratic delays in updating eligibility when people relocate can lead to situations where multiple states are paying for the same person's benefits. In 2019 and 2020, a significant number of people were concurrently enrolled in two states, with over 208,000 beneficiaries in August 2019 and over 327,000 in August 2020, incurring substantial costs. 

[Fnord 2,106]

12 hours ago, easilyscan said:

Not millions, but enough to merit further investigation.

While it's technically impossible to be enrolled in Medicaid in multiple states simultaneously, bureaucratic delays in updating eligibility when people relocate can lead to situations where multiple states are paying for the same person's benefits. In 2019 and 2020, a significant number of people were concurrently enrolled in two states, with over 208,000 beneficiaries in August 2019 and over 327,000 in August 2020, incurring substantial costs. 

While nobody should have a problem with having individuals registered in multiple states being purged from all but their home state, enrollment snafus do not equate to fraud. The current tactic the GOP is embracing will cut the rolls of eligible recipients by burying them in useless paperwork and requiring them to re-apply every six months. These are things that past administrations have worked to alleviate, but are now being purposely undone. 

The largest perpetrators of fraud to Medicare/Medicaid are providers, labs, nursing homes, etc. submitting claims for services that were never rendered, overcharging for their services, or falsifying diagnoses in order to get paid. Seems like identifying and prosecuting those criminals is too much work, so instead they will kneecap the ability of the people that need it to acquire and use it.

[squistion 2,016]

19 hours ago, Fnord said:

Wondering how/where Tony got this info. Not sure it's true, but if it is it seems like there's a big problem with the verification process for eligibility. Do you have a link?

It isn't. Completely false, which is why no link was provided.

[easilyscan 897]

3 hours ago, Fnord said:

While nobody should have a problem with having individuals registered in multiple states being purged from all but their home state, enrollment snafus do not equate to fraud. The current tactic the GOP is embracing will cut the rolls of eligible recipients by burying them in useless paperwork and requiring them to re-apply every six months. These are things that past administrations have worked to alleviate, but are now being purposely undone. 

The largest perpetrators of fraud to Medicare/Medicaid are providers, labs, nursing homes, etc. submitting claims for services that were never rendered, overcharging for their services, or falsifying diagnoses in order to get paid. Seems like identifying and prosecuting those criminals is too much work, so instead they will kneecap the ability of the people that need it to acquire and use it.

This makes a lot of sense. The good news is they do seem to be going after and punishing those providers who are committing the fraud. (See Link) The bad news is what you mentioned in the last half of your last sentence. If that's true, it's very unfortunate. 

https://ccf.georgetown.edu/2025/01/10/the-truth-about-fraud-against-medicaid/

[SaintsInDome2006 439]

On 5/20/2025 at 2:44 PM, easilyscan said:

Probably.

The indictment announced Tuesday alleged Happy House Behavioral Health LLC was paid the money for services that were either never provided or only partially completed and that there was billing for clients who were deceased and incarcerated.

Money laundering charges alleged Happy House Behavioral Health paid $5 million in July 2023 to a Hope of Life International Church, which later wired $2 million to an entity in Rwanda.

Maybe they should've named it happy hour behavioral health instead. Similar to what the Somali are doing to Minnesota.

https://apnews.com/article/arizona-medicaid-fraud-sober-living-native-americans-5dbebe90d8443230441f364ab880b9c2

GOP Sen. Rick Scott was CEO of a company, Columbia-HCA, which was found to have defrauded Medicare & Medicaid customers & the US government, to the tune of 14 felony convictions and $1.7 billion in fines and even greater damages. He's the GOP pointman for negotiating and talking about Medicare and Medicaid funding.

[EternalShinyAndChrome 3,929]

Just now, SaintsInDome2006 said:

GOP Sen. Rick Scott was CEO of a company, Columbia-HCA, which was found to have defrauded Medicare & Medicaid customers & the US government, to the tune of $1.7 billion in fines and even greater damages. He's the GOP pointman for negotiating and talking about Medicare and Medicaid funding.

Stay on topic, zealot.

[SaintsInDome2006 439]

Just now, EternalShinyAndChrome said:

Stay on topic, zealot.

Maybe I misread the OP. I thought the point was about medicaid fraud. It's a huge issue and it's been going on for years. There have been big arrests in my area under both parties.

[easilyscan 897]

53 minutes ago, SaintsInDome2006 said:

There have been big arrests in my area under both parties.

I hope to see that continue, and also hope the penalties/sentences are harsh enough to make other organizations think twice when contemplating taking advantage of Medicaid/Medicare.

[Fnord 2,106]

18 hours ago, easilyscan said:

This makes a lot of sense. The good news is they do seem to be going after and punishing those providers who are committing the fraud. (See Link) The bad news is what you mentioned in the last half of your last sentence. If that's true, it's very unfortunate. 

https://ccf.georgetown.edu/2025/01/10/the-truth-about-fraud-against-medicaid/

Good article, thanks.

It reminded me of my days as a medical biller at a small, rural clinic in Northern California. Medical billing is a sadomasochistic career, I only took it because there was no other work and they couldn't find anyone else that was reasonably competent. Dealing with MCR and Medicaid can be brutal from the provider side. For that matter, private insurers are probably as bad or worse.

I would daily submit claims that were turned down for "errors" that did not exist. Denials for diagnosis codes were very common. I remember literally using an electric typewriter to try to fix claims that Medicare said were not "formatted correctly." It was a full time job just to track denials at a tiny little clinic in the middle of nowhere. I cannot imagine coding and billing for a massive hospital network. With these cuts, a lot of small clinics and hospitals may be done for, which will disproportionately affect rural Republican voters. Meanwhile, cuts in other enforcement areas will lessen the chances of the fraudsters being identified and prosecuted.

Big Medicine and Big Insurance in this country is soooo fuct up, and neither party has any interest in making things better, it seems.