Medicaid regulations are complex, and the program is constantly reviewed by government agencies for a number of reasons, especially to prevent unnecessary financial losses. A recent Medicaid audit in Florida was tied to millions of dollars that were paid out for various drugs. 

Medicaid claims were audited to spot potential problems

The review of several million claims raised questions about medications and services that were tied to various forms of long term care. Florida’s auditor general said that potential issues with these claims resulted in over $5.4 million of additional spending that would be investigated. They suspect that some people may have been receiving prescriptions to re-sell the drugs illegally, which unfortunately raises program costs for everyone. The state’s Agency for Healthcare Administration had initially said that they did not suspect any foul play after the audit, because a valid prescription from a healthcare provider would be required to obtain any controlled substances. There is also a utilization management system that is designed to flag any potentially problematic transactions. 

Most people in Florida who receive any kind of Medicaid services do so through the state’s managed care plans. These are paid for through a monthly fee arrangement. Others are enrolled in a plan that is essentially pay per service as the person needs to make doctor’s visits or receive medication, like standard health insurance.  

Auditors who reviewed these transactions said that more oversight and safeguards should be put in place. This would both save money and ensure that people who are prescribed opiates would not abuse them or overdose. There are also operational audits to ensure that services provided are in compliance with any contracts that dictate what is covered under Medicaid rules and regulations. 

The review raised concerns about billing fraud in addition to the medication payments. There were some odd claims submitted, including a procedure for multiple root canals on the same patient by a dentist over the course of several hours.  

Medicaid costs can become a serious problem

As this news story shows, Medicaid can be an expensive and problematic program. However, many people depend on the program to survive as they age and experience health problems. Someone can quickly lose their savings or retirement accounts if appropriate measures were not taken in advance to plan for sudden expenses.  

The best remedy for this problem is to get professional help from someone who focuses on handling Medicaid issues and retirement planning. They can guide you through the process of securing your family’s financial future. 

Speak with a local professional about Medicaid planning

If you want to get more information about how to prepare for costs associated with Medicaid and other issues that tend to affect people as they age, there is legal help available. Contact:

The Estate, Trust, and Elder Law Firm

850 NW Federal Highway, #1004, Stuart, FL 34994

772-261-8556

www.etelf.com

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