Medicaid and Medicare Discussion and Assignment

Discussion Question:

Locate a recent new story involving a Medicaid fraud and or abuse scenario and summarize the report finding. Decide if the reported scenario is fraud or abuse and explain why or why not. Articles needs to be referenced and cited in your discussion.

Discussion Question:

Research Medicaid eligibility in your state and discuss your findings. Also discuss the requirements to qualify to receive Medicaid benefits under the three categories: categorically needy, medically needy, and special groups. Website needs to be referenced and cited in your discussion.

Assignment:

For this assignment the student will create a PowerPoint to address the following scenario…

You are preparing an orientation module to teach incoming nurse practitioners about Medicare and Medicaid. You presentation should address the following, and language should be directed at entry-level medical personnel:

1. Medicare Parts A: Eligibility and What is covered and not covered (2-4 slides)
2. Medicare Parts B: Eligibility and What is covered and not covered (2-4 slides)
3. Medicare Parts C: Eligibility and Coverage (2-4 slides)
4. Medicare Parts D: Eligibility and Coverage (1-2 slides)
5. Medigap and supplement insurance (1-2 slides)
6. Medical necessity (1-2 slides)
7. Limiting charges (1-2 slides)
8. Process of patient registration (2-3 slides)
9. Medicaid guidelines and eligible groups (3-5 slides)
10. Medi-Medi (2-4 slides)
11. Medicaid verification (1-3 slides)

Include a title and reference slide. Insure all information is referenced and cited in your slides

Assignment Expectations:

• Length:
  • answers must thoroughly address each question in a clear, concise manner; complete answers will be presented in 19 to 36 slides
• Structure:
  • Use the tips at http://www.garrreynolds.com/preso-tips/design/ to create the slideshow. Because good PowerPoints have very few words, submit a script that describes the content of each slide – about 50 words per slide (placed in a separate Word document)
  • Title and reference slides are required
• References:
  • Need to be in APA format on a reference slide, and cited in the slides.
• Format:
  • Save your assignment as a Microsoft PowerPoint (.ppt or .pptx)
• File name:
  • name your saved file according to your last name, first initial and the week (for example, “jonesb.week1”)
• Submission:
  • submit your assignment to the Drop Box

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SAMPLE DISCUSSION POSTS

Discussion 1

A man, Abdikadir Maow from Medford was found guilty of defrauding Medicaid by falsely submitting claims to MassHealth for Personal Care Attendant (PCA) services that were not offered (Office of the Attorney General (OAG), 2022). The man was sentenced to one year in the Middlesex House of Correction for his role in the scheme. He was found guilty of Medicaid False Claims and Larceny by False Pretenses over $1200. In addition to the jail sentence, he was ordered to pay $112,000 in restitution. Abdikadir Maow was indicted in October 2020 as part of a program where seven people were charged with PCA fraud cases. The office of the attorney general alleged that Maow and his PCA engaged in a scheme to falsify and submit timesheets for PCA services that Maow did not receive from PCA.

According to the attorney general’s office, Maow’s PCA billing and receiving payments for PCA hours allegedly offering during times when the PCA or Maow were residing or traveling out of the country separately for a long time or when the PCA was working at a secondary employer (OAG, 2022). The attorney general’s office provided evidence showing that Maow defrauded Medicaid with more than $112,000 in fraudulent billing to MassHealth. The scenario is fraud because the accused was found guilty of submitting claims and causing Medicaid to pay his PCA for services that he did not receive. It is also a fraud because Maow deliberately intended to gain financial benefits for working with the PCA to submit claims for services that were not rendered to him using deceptive means.

Reference 

Office of the Attorney General. (2022). Press release AG Healey’s Medicaid Fraud Division recovers more than $71 million in Federal fiscal year 2022. mass.gove. https://www.mass.gov/news/ag-healeys-medicaid-fraud-division-recovers-more-than-71-million-in-federal-fiscal-year-2022

Discussion 2

In the State of Florida, Medicaid is administered by the Florida Agency for Health Care Administration (AHCA). For one to be eligible for Florida Medicaid, one must be a resident of the state of Florida (Benefits.Gov, n.d). Second, they must be a US citizen, national, legal alien, and a permanent resident. Third, the individual should need health care/insurance assistance. Fourth, the financial situation of the individual should be characterized as low income or very low income. Fifth, the individual must be 65 years of age or older, disabled, blind, family member in your household with a disability, be responsible for a child 18 years of age or younger, or be pregnant (Benefits.Gov, n.d). 

Medicaid benefits are offered in Florida through various categories. The first category is categorically needy. This category covers individuals who are receiving SSI benefits, whose income is 138% of the federal poverty level (FPL), aged, disabled, or blind (Benefits.Gov, n.d). The second category is medically needy. Individuals in this category have an income level that is higher FPL but has high medical expenses. The income limit for this category is determined by the Florida Department of Children. The last category is special groups. This group has unique Medicaid eligibility criteria. They include those diagnosed with cervical or breast diagnosed through Florida Breast and Cervical Cancer Early Detection Program, those in nursing homes or other long-term care facilities, and those who need long-term care but wish to receive care from their community or home settings (Benefits.Gov, n.d). 

Reference 

Benefits.Gov. (n.d). Florida Medicaid. https://www.benefits.gov/benefit/1625

SAMPLE ASSIGNMENT