Medicaid Assistance Investigation - ADVICE PLEASE -

[ilherman]

I got a call today from the Medicaid investigation office that I need to come down and discuss with them something. When I asked what it is they said that back in '14 I was receiving Medicaid assistance while I was having a third party Insurance at the same time. They claim that when I have third party insurance I am not allowed to receive medicaid assistance unless I notify them beforehand and they allow it.

They want $1,600 for the premiums they paid while I was covered under the third party insurance. In fact I didn't even know at that time that I had third party Insurance. I was under a family plan which I didn't even know that I am under.

Anyone with experience? Anything to do at this point?

[ckmk47]

I've heard of this with a few people recently.  That they are investigating for medicaid fraud.
I think they're more than ready to settle for monetary compensation.  Theoretically they can prosecute for fraud and send people to jail.
Probably contact a lawyer with experience in this field. Then pay what you have to.
Good luck.

[beeweegee]

I've heard of this with a few people recently.  That they are investigating for medicaid fraud.
I think they're more than ready to settle for monetary compensation.  Theoretically they can prosecute for fraud and send people to jail.
Probably contact a lawyer with experience in this field. Then pay what you have to.
Good luck.

Are the recent investigations you are referring to similar to this one? Or are they about not meeting proper income requirements, etc.? I have heard of recent cases of the latter - I wonder if this case is part of the same wave of investigations, or if it may just be coincidence. If it's just a coincidence, the OP may be in much better shape than what you're describing.

[ckmk47]

It was probably not meeting proper income requirements.
You may be right.

[coralsnake]

Essentially they are the same- Not meeting eligibility requirments. 

However IMO overlooking existing coverage is much easier to explain and possibly negotiate down/away any penalties.

[beeweegee]

Essentially they are the same- Not meeting eligibility requirments. 

However IMO overlooking existing coverage is much easier to explain and possibly negotiate down/away any penalties.

+1 It sounds like the only issue the OP is dealing with is the $1600, not any potential legal issues. Meaning, they will be happy if they get their money and move on.

[sillypainter]

I got a call today from the Medicaid investigation office that I need to come down and discuss with them something. When I asked what it is they said that back in '14 I was receiving Medicaid assistance while I was having a third party Insurance at the same time. They claim that when I have third party insurance I am not allowed to receive medicaid assistance unless I notify them beforehand and they allow it.

They want $1,600 for the premiums they paid while I was covered under the third party insurance. In fact I didn't even know at that time that I had third party Insurance. I was under a family plan which I didn't even know that I am under.

Anyone with experience? Anything to do at this point?

I have a friend who had similar issues with not reporting an increase of wages (long story). They are here to be paid back, so no worries there, no FBI knocking on your door in the wee hours of the night.

I would still ask the local Jewish organizations if you should go down or settle it by sending them a check (my friend was advised to write out a check in the amount they claimed he owed and not come down, because they make you sign documents that you are admitting to the fraud). Do not handle this on your own.

[Work-for-ur-muny]

Essentially they are the same- Not meeting eligibility requirments. 

However IMO overlooking existing coverage is much easier to explain and possibly negotiate down/away any penalties.

Not quite. I had family coverage and had medicaid at the same time. I knew it already that every time I called the medicaid insurer they would immediately ask me if I have any other coverage. I always admitted the truth and it didn't affect my medicaid eligibility.

[ilherman]

Thanks guys for your responses. Its not about misreporting income. Its just about having a third party insurance while receiving Medicaid.

Which organization should i contact for advice?

[churnbabychurn]

Not quite. I had family coverage and had medicaid at the same time. I knew it already that every time I called the medicaid insurer they would immediately ask me if I have any other coverage. I always admitted the truth and it didn't affect my medicaid eligibility.

It affects your allowable income level.

[Work-for-ur-muny]

Thanks guys for your responses. Its not about misreporting income. Its just about having a third party insurance while receiving Medicaid.

Which organization should i contact for advice?

I would say your best chance is to begin by consulting one of the knowledgeable private guys who do re-certification, they'll probably direct you in the right way.

[avromie7]

Which organization should i contact for advice?

I think yeled v'yalda

[David Smith]

I think yeled v'yalda

Or Ezra.