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Health Care Finance - Essay Example

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Medicaid ensures that proper healthcare is provided to any person who cannot afford to pay their health bill. This can be done by paying for the entire bill or contributing to it. By catering to the needs of the lower income groups, it pays the bills directly to the hospital instead of rallying them through the individual himself…
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Health Care Finance
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BHS 427 - Health Care Finance (Module 5-CBT) ID: Word count: 537 words Medicaid ensures that proper healthcare is provided to any person who cannot afford to pay their health bill. This can be done by paying for the entire bill or contributing to it. By catering to the needs of the lower income groups, it pays the bills directly to the hospital instead of rallying them through the individual himself. Most importantly, aid is given to American citizens or the lawfully admitted immigrant.
Medicaid fraud is generally committed by individuals seeking to collect healthcare reimbursements under false pretences. At instances like these Medicaid services render the help of the False Claims Act. This act aims at punishing all those who: give false certifications or false information, pretend to be in need of medical necessity or self referrals which allow a physician to gain money through referring a patient to a facility in which he has a monetary interest. All matters like these are presented to the False Claims Act who intervenes through several ways: acting as a plaintiff, allowing the realtor to prosecute on behalf of the US government or dismissing the complaint if it is against government policy. An instance like this date back to 1998 when the Assistant Secretary of Legislation was asked to review the healthcare department as incorrect billing had led to a loss of $6 billion. (Morris) Instances like these can also be presented and placed under the False Claims Act.
In 2005 the dramatic deficits made by the government forced the Deficit Reduction Act to allow the Congress to decide that the Centers of Medicaid and its services(CMS) were to establish the Medicaid Integrity Plan. This plan was created to suit two purposes: to use contractors who would identify overpayments and audit claims and to provide support to combat fraud and abuse ( The most efficient manner for eradicating frauds is to deploy precautionary measures to avoid even its initiation. One of the ways to achieve this is by having due diligence deployed on providers and suppliers prior to issuing them the Medicare numbers, which would enable them to bill Medicare. Ever since it was created, CMS has been focusing resources on front-end controls with the end goal of reducing or eliminating common schemes by sham providers by thoroughly vetting all providers before allowing them to obtain a Medicare enrollment number.
The Deficit Reduction Act of 2005 was passed as an Act of Congress. Enforced over a period of five years each, the Act is said to save nearly $40 billion over five years from mandatory spending programs through slowing the growth in spending for Medicare and Medicaid, changing student loan formulas, and other measures. This is because the Act makes it harder to obtain insurance by closing loopholes such as terming life estate as an asset or preventing states from rounding off fractional periods of ineligibility to any citizen.
Through these moves the government aimed to ensure that states will be able to reconnect their healthy populations to the larger health insurance system. This could transform long-term care from an institutionally-based, provide-driven system to a person-centered and consumer-controlled model. Through these acts, there could be great opportunities for covering more people at a lower cost, without hampering that greater continuity of coverage.
HHS,gov, Comprehensive Medicaid Integrity Plan, viewed June 13 2009
Morris.L, Testimony on False Claims Act, Assistant Secretary for Legislation, viewed June 14 2009 Read More
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