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How can we help medicaid from not getting scammed by doctors of trying to over charge it?

I think the own Doctors are the ones that commit fraud by over charging medicaid or lying that they did something to us patients when its not even true, I think to fix part of this they should send us a sheet saying everything that the doctor stated he suppousably did and we go threw it to see if its true or not and if it is we put our comments and sign it and return it to them because recently I had a hernia umbilical surgery and the doctor didnt want to give me an xray to see if it was really a hernia or not and he just went and did the surgery and I dont think I even had a hernia to begin with, he told me it was a tiny one but I think he lied just to get money out of the medicaid. Plus he left my bellybutton all deformed and he lied it was going to go back to normal within 2 to 3 month at the most and 5 months have passed and it still looks deformed and it wasnt like that before the surgery. He left it like a triangle now:(

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Asked by Anonymous at 5:51 AM on Aug. 28, 2009 in Politics & Current Events

Answers (5)
  • It is hard to lie to Medicaid. I know I used to bill them for my services. You cannot over charge for a specific service....because they only pay a set amount. You may charge normally $200 for an inital consult but Medicaid may only pay $120. Medicaid also does audits of your charts and your charts of other non Medicaid patients to make sure your medical notes reflect the servie you billed for. If you have no notes that is fraud. If you billed up for service or Medicaid regulations changed it is called a payback. Many medical places do not like Medicaid because of the way they can come in and look at all your charts, not just the Medicaid ones. There are a ton of is hard to know what your are doing unless you have an outside billing source or a billing department. But it is very difficult for private insurance as well, sometimes more so. It sounds like you just got a very bad doctor.

    Answer by frogdawg at 6:21 AM on Aug. 28, 2009

  • All insurance companies including Medicaid have what is called a reasonable and customary cost to keep doctors from over charging for services. You should see what your bill would be if you had no insurance. Plus I have never seen a doctor do his own billing, thats funny to think a doctor is really doing that.

    Answer by Anonymous at 7:35 AM on Aug. 28, 2009

  • No Dr can operate on you without your permission and have you never heard of a second opinion?
    What you talk about here does happen on a small scale but there is something called personal responsibility. I'm not going to let a Dr. cut on me if I am not comfortable with it. Most if not all insurance covers a second opinion.
    I do agree we should get itemized bills though.

    Answer by itsmesteph11 at 8:00 AM on Aug. 28, 2009

  • actually its very easy to lie to medicaid and medicare. i've tried in the past to report a doctor in AL for fraud. i copied all the necessary documentation, all the checks and eob's, all the related computer information and banking info over about 3 months. nothing was done because he was a dr. in a rural area and one of only a handful of providers. he is still in practice.
    and i agree wholeheartedly, patients need to start taking some personal responsibility before hand and stop trying to sue for absolutely everything afterwards. driving up liability costs and then b--ching healthcare is expensive.
    why the hell do you think its so expensive when everyone is so eager to be irresponsible but sue happy?

    Answer by jewjewbee at 8:10 AM on Aug. 28, 2009

  • I worked for Dr.s & hospitals for years doing Medicare and Medicaid billing. They audit charts yearly, kick out questionable charges, request medical records, do regular office inspections, etc. If anything is out of order, they will look at each and every record. They do have checks and balances in order.

    Answer by mancosmomma at 9:32 AM on Aug. 28, 2009

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