Articles Tagged with Medicaid

hush-naidoo-382152-copy-300x200The government is trying to review and reform the healthcare system, but there are still some people in Chicago who are committing Medicaid fraud. There are many fraud prevention measures that have been put in place. Yet, there are people who work to see how they can deceive the government.

This is a serious offense that can lead to serious jail time. Recently, Santila Terry, a 45-year-old woman who lives in Chicago, was facing charges for committing both identity and Medicaid fraud. The total estimated loss in the case was almost $1 million. This case is typical in terms of how frauds of that nature are committed.

A service provider bills the government for services that were never delivered right up until they are discovered. According to reports from the Attorney General, Santila was claiming to provide speech therapy to people who did not exist. Another part of the case was identity fraud. Special Therapy Care Chartered used the personal information and Medicaid service provider ID of a previous employee to falsely bill the government.

daan-stevens-282446-copy-300x191It is a controversial move but one that is considered to be a reflection of the reality that many state governments are not able to sustain the increasing healthcare costs of their citizenry. Chicago is no exception, and its new managed care provisions reflect a need for reform. Recently, the state has amended the law in such a way as to move Medicaid users towards the more affordable managed care options. Like any change, there are political and legal ramifications to this one. Some have argued that the changes are inhumane and could actually constitute a illegal or unconstitutional act. At the moment, the supreme court has not yet fully pronounced itself on the matter.

Meanwhile, the provisions of the law continue to impact the citizens of Chicago. It is particularly onerous for those who are disabled in some way or another. There are benefits to the managed care options, including an investment in infrastructure such as ramps. However, some of the Medicaid users feel that there will also be an additional administrative burden and the possibility of being rejected for full benefits. The changes are based on a public-private partnership model that has been used in other areas of public spending. In this case, not-for-profit organizations such as the Community Care Alliance are given access to some funds and income generating opportunities so that they can provide services that better reflect the needs of the service users.

Practical and Administrative Changes