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Message
Possible solution to Medicaid Fraud: very modest coinsurance with rebates
Posted on 5/28/26 at 9:03 pm
Posted on 5/28/26 at 9:03 pm
One of the reasons Medicaid is so easy to defraud is because patients do not get EOBs involving coinsurance. Doctors can bill fake visits and the patients don’t care. It’s not coming out of their pocket
If, instead, Medicaid institutes across the board coinsurance, patients will get their EOBs and freak out.
This accomplishes two things:
1) reduces Medicaid strain on state and federal budgets
2) reduces incentive for doctors to bill fake visits
The coinsurance rate can be tiny….like 1 or 2%. A low income Medicaid recipient will be highly sensitive at even low rates like that.
There could also be rebates for vulnerable groups
If, instead, Medicaid institutes across the board coinsurance, patients will get their EOBs and freak out.
This accomplishes two things:
1) reduces Medicaid strain on state and federal budgets
2) reduces incentive for doctors to bill fake visits
The coinsurance rate can be tiny….like 1 or 2%. A low income Medicaid recipient will be highly sensitive at even low rates like that.
There could also be rebates for vulnerable groups
This post was edited on 5/28/26 at 9:26 pm
10
Posted on 5/28/26 at 9:06 pm to HailHailtoMichigan!
quote:
HailHailtoMichigan!
No.
Posted on 5/28/26 at 9:07 pm to HailHailtoMichigan!
How about this?
Fraud/theft of taxpayer funds in excess of $1M carries the death penalty.
Done.
If I wrote the legislation, I'd drop the threshold to $100k.
Fraud/theft of taxpayer funds in excess of $1M carries the death penalty.
Done.
If I wrote the legislation, I'd drop the threshold to $100k.
This post was edited on 5/28/26 at 9:09 pm
Posted on 5/28/26 at 9:10 pm to HailHailtoMichigan!
Where did you get that information? Medicaid recipients get EOBs and it also prohibits providers from refusing service if the patient refuses to pay a copay.
Recipients don’t care because it’s free, and the state doesn’t care because it’s federal money.
Recipients don’t care because it’s free, and the state doesn’t care because it’s federal money.
Posted on 5/28/26 at 9:10 pm to VoxDawg
quote:
Fraud/theft of taxpayer funds in excess of $1M carries the death penalty.
This. The reason it's so widespread and rampant, is because the consequences are miniscule. They don't fit the crime.
Posted on 5/28/26 at 9:12 pm to lsuconnman
quote:
Medicaid recipients get EOBs
Not with a “what patient owes” section, which was my point
Coinsurance and copays are statistically proven to reduce fraud in private sector and Medicare
Posted on 5/28/26 at 9:15 pm to Pondyrosa
I'll even be a benevolent despot - if full restitution + penalties and interest (no less than 20%) are repaid within 30 days of sentencing, the guilty can attempt to make the case for serving a sentence equal to the maximum guidelines for tax evasion for the full amount embezzled from the taxpayers.
Posted on 5/28/26 at 9:17 pm to VoxDawg
Note: The maximum sentencing allowed for tax evasion should be calculated on the entire amount stolen as being the amount of tax owed/evaded.
Posted on 5/28/26 at 9:19 pm to HailHailtoMichigan!
You can’t really do that for truly disabled people who make nothing. It’s not something you can do across the board.
How about we continue putting people who commit fraud in jail? Just get more proactive with it.
I’m also up for the idea of making them work off their theft.
How about we continue putting people who commit fraud in jail? Just get more proactive with it.
I’m also up for the idea of making them work off their theft.
This post was edited on 5/28/26 at 9:22 pm
Posted on 5/28/26 at 9:27 pm to HailHailtoMichigan!
quote:
One of the reasons Medicaid is so easy to defraud is because patients do not get EOBs involving coinsurance. Doctors can bill fake visits and the patients don’t care. It’s not coming out of their pocket If, instead, Medicaid institutes across the board coinsurance, patients will get their EOBs and freak out. This accomplishes two things: 1) reduces Medicaid strain on state and federal budgets 2) reduces incentive for doctors to bill fake visits The coinsurance rate can be tiny….like 1 or 2%. A low income Medicaid recipient will be highly sensitive at even low rates like that.
Another option is to provide a small yearly medical expense account for medicaid patients to use for the “copay”.
Yes, it will be abused by some, but there has to be some incentive for patients to choose cost effective treatment and not waste their yearly medical card stipend of maybe $300. It would not be cumulative year to year, and could only be used for certain approved medical uses.
Posted on 5/28/26 at 9:32 pm to HailHailtoMichigan!
quote:
Not with a “what patient owes” section, which was my point
Because the patient always owes $0, and technically there is coinsurance, it’s the state…which is also the reason they don’t voluntarily audit beyond minimum requirements.
Posted on 5/28/26 at 10:05 pm to HailHailtoMichigan!
Dedicate patients only get one doctor visit per month and does because of that they go to the emergency room frequently and many times it is not an emergency. I always said if Medicaid allowed the hospitals to collect a $10 co-pay on Medicaid patients it would cut the volume down drastically on nonemergency patients.
Posted on 5/29/26 at 5:16 am to HailHailtoMichigan!
I was told a $5 co-pay was racist.
Posted on 5/29/26 at 6:02 am to HailHailtoMichigan!
quote:
reduces incentive for doctors to bill fake visits
You know what else reduces incentives for fake billing?
…. jail time and loss of license
Posted on 5/29/26 at 6:14 am to cadillacattack
Further penalty should include seizing all property and putting people around the criminal on the streets.
Posted on 5/29/26 at 6:37 am to HailHailtoMichigan!
No.
Imprisonment or execution (depending on victims and amounts).
Immediate deportation of any fricking foreigners involved.
Imprisonment or execution (depending on victims and amounts).
Immediate deportation of any fricking foreigners involved.
Posted on 5/29/26 at 7:16 am to HailHailtoMichigan!
How about we develop quotas for doctor visits based on privately insured patients. Have to pay beyond that benchmark unless under specialist care, and all specialist care provided in Medicaid only system.
Medicaid recipients are poor by definition. They don’t have shite to do so they go to the doctor in their free time. Got to stay poor for the free care. It’s a poverty cycle. The fraud is a function of the sheer volume of cases.
Medicaid recipients are poor by definition. They don’t have shite to do so they go to the doctor in their free time. Got to stay poor for the free care. It’s a poverty cycle. The fraud is a function of the sheer volume of cases.
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