Comments on: Behind the he said, she said on Medicaid reform https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/ Your Illinois news radar Tue, 09 Jun 2026 21:41:38 +0000 http://wordpress.org/?v=2.0.4 by: DuPage Dave https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218981 Tue, 18 Sep 2012 23:25:08 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218981 "Medicaid roles"? Anybody at the Pantagraph paying attention? “Medicaid roles”? Anybody at the Pantagraph paying attention?

]]> by: AFSCME Steward https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218977 Tue, 18 Sep 2012 23:07:08 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218977 illini The problem is state policy regarding income. For years, with passive redetermination, All Kids recipients were not required to report or verify income if they only wanted to receive mdical for persons 19 or under. Income only needed to be reported if coverage was desired for adults. It is possible that the number of ineligible households approaches 25%, but my experience of 32 years on the front lines as a caseworker & casework supervisor makes me feel this is probably a little on the high side. We have computer access to the department of labor data, which allows us to see current unemployment benefits being received and earnings (updated quarterly). We also receive cross matches about tax returns and bank accounts. We also have access to the Social Security system, which shows current SSI & RSDI benefits. One of the problems we encounter is failing to report a spouse with income in the home. We frequently catch these through birth records from the Vital records clearances we have access to. We match the Social Security Number of the parent with employment records & other income sources previously named. If there is any indication of fraud an investigator is sent out. A very large number of cases we send for investigation are cancelled because it is determined that the father of the children is present in the home. Te idea being discussed out here that a person can only report one job & not the other isn't true. "@illinifan Interesting, but sad, information. So, if I was willing to act unethically and illegally, I could work my full-time job, plus an additional part time job. I could then apply for Medicaid (and probably SNAP)by providing DHS with only my paystubs from my part-time job, nobody would further question me? You’re telling me that I would be considered eligible for these tax-funded benefits, eliminate my pre-tax deduction of my outrageous health insurance premiums (Medical Card), and possibly reduce my grocery bill (LINK Card)?!?! Wow. " illini

The problem is state policy regarding income. For years, with passive redetermination, All Kids recipients were not required to report or verify income if they only wanted to receive mdical for persons 19 or under. Income only needed to be reported if coverage was desired for adults. It is possible that the number of ineligible households approaches 25%, but my experience of 32 years on the front lines as a caseworker & casework supervisor makes me feel this is probably a little on the high side. We have computer access to the department of labor data, which allows us to see current unemployment benefits being received and earnings (updated quarterly). We also receive cross matches about tax returns and bank accounts. We also have access to the Social Security system, which shows current SSI & RSDI benefits. One of the problems we encounter is failing to report a spouse with income in the home. We frequently catch these through birth records from the Vital records clearances we have access to. We match the Social Security Number of the parent with employment records & other income sources previously named. If there is any indication of fraud an investigator is sent out. A very large number of cases we send for investigation are cancelled because it is determined that the father of the children is present in the home. Te idea being discussed out here that a person can only report one job & not the other isn’t true.

“@illinifan
Interesting, but sad, information. So, if I was willing to act unethically and illegally, I could work my full-time job, plus an additional part time job. I could then apply for Medicaid (and probably SNAP)by providing DHS with only my paystubs from my part-time job, nobody would further question me? You’re telling me that I would be considered eligible for these tax-funded benefits, eliminate my pre-tax deduction of my outrageous health insurance premiums (Medical Card), and possibly reduce my grocery bill (LINK Card)?!?! Wow. “

]]> by: Robert the Bruce https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218954 Tue, 18 Sep 2012 20:22:32 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218954 Anyone in the general assembly complaining about a project time frame when they've accomplished nothing yet on pension reform is laughable. But Medicaid fraud investigation is a project that cries out for some nepotism - Maximus should hire a relative of one of the republican members of the general assembly to work on this project and also task the relative with briefing republican members of the General Assembly. When he/she finds out that Medicaid fraud by recipients isn't as widespread as believed, maybe they'll complain less. Anyone in the general assembly complaining about a project time frame when they’ve accomplished nothing yet on pension reform is laughable.

But Medicaid fraud investigation is a project that cries out for some nepotism - Maximus should hire a relative of one of the republican members of the general assembly to work on this project and also task the relative with briefing republican members of the General Assembly. When he/she finds out that Medicaid fraud by recipients isn’t as widespread as believed, maybe they’ll complain less.

]]> by: Steamer https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218942 Tue, 18 Sep 2012 19:56:30 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218942 It's expected thatMaximus will "electronically" examine income, assets, etc. a great idea, but there's no way to perform the job at the current time. The only database that indicates income per quarter, is always at least 90 days behind. The goal is to limit or stop physical contact with applicants which if successful would lower the need for staffing! Think it's a mess now...you ain't seen nothin' yet!!!! It’s expected thatMaximus will “electronically” examine income, assets, etc. a great idea, but there’s no way to perform the job at the current time. The only database that indicates income per quarter, is always at least 90 days behind. The goal is to limit or stop physical contact with applicants which if successful would lower the need for staffing! Think it’s a mess now…you ain’t seen nothin’ yet!!!!

]]> by: illinifan https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218900 Tue, 18 Sep 2012 18:55:52 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218900 "wordslinger" health care providers do make money and do commit Medicaid fraud but that is not the sole driver of Medicaid fraud. This keeps circling the general issue of access to health care. If there was universal access, then we would not spend time and money tracking Medicaid fraud since all persons would have coverage. That would be a huge cost savings to the health care system. We then need to tackle how people use health care and particulary the ER. Many people go to the ER for basic care since they know since 1986 all ERs have to treat patients regardless of the ability to pay. As a result of this, an ER then became the primary care provider for the uninusred. We need to change that process, and would reduce some costs. I agree with you some how we have to quit making people the enemy and quit making the government the enemy. We are partners in this mess, and until we stop standing in a circular firing squad shooting at the enemy we won't get anything done. “wordslinger” health care providers do make money and do commit Medicaid fraud but that is not the sole driver of Medicaid fraud. This keeps circling the general issue of access to health care. If there was universal access, then we would not spend time and money tracking Medicaid fraud since all persons would have coverage. That would be a huge cost savings to the health care system. We then need to tackle how people use health care and particulary the ER. Many people go to the ER for basic care since they know since 1986 all ERs have to treat patients regardless of the ability to pay. As a result of this, an ER then became the primary care provider for the uninusred. We need to change that process, and would reduce some costs. I agree with you some how we have to quit making people the enemy and quit making the government the enemy. We are partners in this mess, and until we stop standing in a circular firing squad shooting at the enemy we won’t get anything done.

]]> by: wordslinger https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218879 Tue, 18 Sep 2012 18:45:10 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218879 Who makes money on Medicaid fraud? The state doesn't cut you a check for going to the emergency room. The folks getting paid are the health-care providers. This is what Illinois GOP leaders have to talk about? And they claim some sort of electoral conspiracy. Has the collective GOP lost its mind? For crying out loud, they see the people as the enemy of the government. Who makes money on Medicaid fraud? The state doesn’t cut you a check for going to the emergency room.

The folks getting paid are the health-care providers.

This is what Illinois GOP leaders have to talk about? And they claim some sort of electoral conspiracy.

Has the collective GOP lost its mind? For crying out loud, they see the people as the enemy of the government.

]]> by: Anonymous https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218877 Tue, 18 Sep 2012 18:44:12 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218877 Yellow D has it on the mark. Go after the BIG dogs - yet that might get, um, complicated with politicians in need of $$$. Bums. How many investigators of Big Vendors are there? Billion$ of bucks and a handful checking it out. It gives the impression of anti- fraud measures, but not serious focus Bums I tell ya.... Yellow D has it on the mark. Go after the BIG dogs - yet that might get, um, complicated with politicians in need of $$$. Bums. How many investigators of Big Vendors are there?
Billion$ of bucks and a handful checking it out. It gives the impression of anti- fraud measures, but not serious focus
Bums I tell ya….

]]> by: illinifan https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218847 Tue, 18 Sep 2012 18:18:11 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218847 Not what I said "income verification" since state offices have immediate data matches with DOL. If a person provides one pay stub from one job, but DOL shows multiple jobs, the workers inquire and ask for proof of the other income, including that it ended. If all the data shows only one job and a pay stub is provided then only one pay stub was used. That did not give a full picture of the actual wage so recently it was expanded to provide 30 days of income proof. You also have to fit a program category to get the coverage either by having children in the home (which you have to prove they are there), or being 65+, blind or disabled. So you can't just walk in and get benefits. Yes some people lie, but once a year tax returns are filed, and then the state has a data match with IRS to pick up on unreported income. If the person is paid cash, guess what the state workers will question people who say rent and bills are paid but they have no income, and the person has to provide some proof how they have been managing to live on nothing. It is not the easy process many people believe it is. Fraud will exist but it is not the level everyone thinks it is and represents about 10-15% of the people. Too high but let's not villainize the 85-90% who are receiving what they are eligible for. Not what I said “income verification” since state offices have immediate data matches with DOL. If a person provides one pay stub from one job, but DOL shows multiple jobs, the workers inquire and ask for proof of the other income, including that it ended. If all the data shows only one job and a pay stub is provided then only one pay stub was used. That did not give a full picture of the actual wage so recently it was expanded to provide 30 days of income proof. You also have to fit a program category to get the coverage either by having children in the home (which you have to prove they are there), or being 65+, blind or disabled. So you can’t just walk in and get benefits. Yes some people lie, but once a year tax returns are filed, and then the state has a data match with IRS to pick up on unreported income. If the person is paid cash, guess what the state workers will question people who say rent and bills are paid but they have no income, and the person has to provide some proof how they have been managing to live on nothing. It is not the easy process many people believe it is. Fraud will exist but it is not the level everyone thinks it is and represents about 10-15% of the people. Too high but let’s not villainize the 85-90% who are receiving what they are eligible for.

]]> by: steve schnorf https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218843 Tue, 18 Sep 2012 18:17:14 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218843 and let's give them a smack or two anyway, since if they aren't guilty of Medicaid fraud they are almost certainly guilty of something else; as a matter of fact we could adopt the old Vietnam standard, just kill them all and let God sort them out. They all look alike anyway. and let’s give them a smack or two anyway, since if they aren’t guilty of Medicaid fraud they are almost certainly guilty of something else; as a matter of fact we could adopt the old Vietnam standard, just kill them all and let God sort them out. They all look alike anyway.

]]> by: Demoralized https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218836 Tue, 18 Sep 2012 18:05:58 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218836 IV: Let's do a strip search of them while we are at it. Maybe they are hiding income in body crevices. IV:

Let’s do a strip search of them while we are at it. Maybe they are hiding income in body crevices.

]]> by: Anyone Remember? https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218834 Tue, 18 Sep 2012 18:03:03 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218834 Contractors to "scrub" Medicaid rolls? Isn't that what MSI was all about? Contractors to “scrub” Medicaid rolls? Isn’t that what MSI was all about?

]]> by: Yellow Dog Democrat https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218808 Tue, 18 Sep 2012 17:19:46 +0000 https://capitolfax.com/2012/09/18/behind-the-he-said-she-said-on-medicaid-reform/#comment-11218808 My grandfather was a fraud investigator for the state. Most "fraud" involves providers, not recipients. Why? The penalties for Medicaid fraud are pretty harsh, and can include jail time. But no patient "makes" money off of Medicaid fraud. On the other hand, providers who think they've figured out a way to game the system...by billing for unnecessary services or services that were never delivered...can make millions. Who would risk jail time to get medical services they can otherwise afford? Not many. Are there people who would risk jail time to make millions? Yes. My grandfather was a fraud investigator for the state. Most “fraud” involves providers, not recipients.

Why? The penalties for Medicaid fraud are pretty harsh, and can include jail time. But no patient “makes” money off of Medicaid fraud. On the other hand, providers who think they’ve figured out a way to game the system…by billing for unnecessary services or services that were never delivered…can make millions.

Who would risk jail time to get medical services they can otherwise afford? Not many.

Are there people who would risk jail time to make millions? Yes.

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