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Started By
Message
CMS Finds 2.8 Million Americans Potentially Enrolled In Two or More Medicaid/ACA Exchange
Posted on 7/21/25 at 6:08 am
Posted on 7/21/25 at 6:08 am
quote:
Unnecessary, Duplicate Enrollment Wasting $14 Billion Annually
quote:
The Centers for Medicare & Medicaid Services (CMS) continue to crush fraud, waste, and abuse in America’s healthcare programs by stopping duplicative enrollment in government health programs, with the potential to save taxpayers approximately $14 billion annually.
A recent analysis of 2024 enrollment data identified 2.8 million Americans either enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states or simultaneously enrolled in both Medicaid/CHIP and a subsidized Affordable Care Act (ACA) Exchange plan.
quote:
LINK
How many hospitals, doctors, providers...have been stealing from us?
The way I understand Medicaid, the money doesn't go to an individual but toward the states and then is disbursed to hospitals, doctors, providers?
Someone help me understand this.
TIA
14
Posted on 7/21/25 at 6:13 am to Reubaltaich
This happens when the same stolen identities are used by different illegals.
Posted on 7/21/25 at 6:16 am to Reubaltaich
RFK said the agencies didn’t communicate with each other.
Posted on 7/21/25 at 6:17 am to Reubaltaich
When they say illegal aliens don’t get Medicaid. LIE. Anyone without health insurance that is admitted to the hospital can spin down to Medicaid and it will cover it.
Posted on 7/21/25 at 6:18 am to udtiger
quote:
This happens when the same stolen identities are used by different illegals.
When my grandfather was dying in a hospital 20 years ago, they continued run test after test on the old man, I finally stepped in and told them to cease the bullshite.
This shite started way before illegals.
Hospitals and doctors are neck deep in the crap.
Posted on 7/21/25 at 6:23 am to Reubaltaich
This is definitely what I voted for
Posted on 7/21/25 at 6:30 am to Reubaltaich
The waste would occur with capitation payments on the multiple states front.
But that would be the result of a poorly run eligibility source in that state not being notified or processing address changes timely.
States don’t want to pay cap they don’t have to pay. So I wouldn’t claim fraud here, just inefficiency or ineffectiveness.
Now fraud comes in when a managed care provider is in multiple states and has the data to prove a member is enrolled multiple times but “chooses” not to notify anyone. I could see that happening.
But that would be the result of a poorly run eligibility source in that state not being notified or processing address changes timely.
States don’t want to pay cap they don’t have to pay. So I wouldn’t claim fraud here, just inefficiency or ineffectiveness.
Now fraud comes in when a managed care provider is in multiple states and has the data to prove a member is enrolled multiple times but “chooses” not to notify anyone. I could see that happening.
This post was edited on 7/21/25 at 7:01 am
Posted on 7/21/25 at 6:32 am to BeesWax
quote:
RFK said the agencies didn’t communicate with each other.
Correct. State agencies do not. CMS, however, should let them know if a member has switched to another state. They have the data.
Posted on 7/21/25 at 6:37 am to FATBOY TIGER
quote:
When my grandfather was dying in a hospital 20 years ago, they continued run test after test on the old man, I finally stepped in and told them to cease the bullshite.
This shite started way before illegals.
Hospitals and doctors are neck deep in the crap.
General Medicaid fraud has nothing to do with the the subject of the OP, or my response.
Posted on 7/21/25 at 6:38 am to udtiger
quote:
This happens when the same stolen identities are used by different illegals.
I imagine this is the largest chunk of it.
Posted on 7/21/25 at 6:40 am to Reubaltaich
The insurers would be the ones profiting. They collect the duplicated premium.
Providers get paid for services actually rendered. (Unless they're running a fraudulent billing scam.)
Providers get paid for services actually rendered. (Unless they're running a fraudulent billing scam.)
Posted on 7/21/25 at 6:52 am to Bestbank Tiger
quote:
Providers get paid for services actually rendered.
Depends on the provider. A managed care organization can be configured as a provider. They have provider Medicaid IDs.
Posted on 7/21/25 at 6:54 am to Bestbank Tiger
quote:
Providers get paid for services actually rendered. (Unless they're running a fraudulent billing scam.)
Covid shots.
Basically they render services not needed.
Posted on 7/21/25 at 6:56 am to Reubaltaich
quote:
Someone help me understand this.
Ten thousand page legislation isn't made to be understood.
Posted on 7/21/25 at 7:00 am to Reubaltaich
doctors dont profit from some person having two different medicaids. dumb comment from ignorant person.
Posted on 7/21/25 at 7:01 am to 97tiger
quote:
doctors dont profit from some person having two different medicaids. dumb comment from ignorant person.
MCOs do.
Posted on 7/21/25 at 7:09 am to Reubaltaich
quote:I am curious how doctors and hospitals are at fault here.
How many hospitals, doctors, providers...have been stealing from us?
This post was edited on 7/21/25 at 7:11 am
Posted on 7/21/25 at 7:17 am to Reubaltaich
If you don't allow duplicate coverage millions will die.
Every Democrat
Every Democrat
Posted on 7/21/25 at 9:18 am to Reubaltaich
quote:
The way I understand Medicaid, the money doesn't go to an individual but toward the states and then is disbursed to hospitals, doctors, providers?
You think hospitals just get payments for who knows what because a person has medicaid?
Posted on 7/21/25 at 10:04 am to Reubaltaich
quote:
CMS Finds 2.8 Million Americans Potentially Enrolled In Two or More Medicaid/ACA Exchange
Reubaltaich
quote:
Unnecessary, Duplicate Enrollment Wasting $14 Billion Annually
Yet we get the daily barrage of sob stories about the cruel cuts in Medicaid funding, of course always about children and minorities from the despicable and deplorable media. The fricking writers know full fricking well the targets are things like this or fraud and abuse and illegal aliens but their Trump Drangement Syndrome will not let them tell the truth.
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