Tag: Medicaid

Audit: W.Va. at Risk of Losing Medicaid Funds

  Legislative auditors say West Virginia is at risk of losing millions of dollars in federal Medicaid funding because state hasn’t complied with a 2011 directive.
 
The directive requires states to suspend Medicaid payments to health care providers if fraud allegations are determined to be credible.
 
A legislative audit says Medicaid has paid at least $17.9 million to providers whose cases were referred to the state’s Medicaid Fraud Unit. The payments could be as a high as $211 million.

 
 The audit was released Tuesday during legislative interim meetings.
 
Bureau for Medical Services counsel Alva Page told lawmakers that the bureau and auditors have different interpretations of the applicable portion of the Affordable Care Act.
 

Health Insurance Coverage Increases in W.Va.

  The number of West Virginians getting health insurance through two programs has increased more than in almost any other state since Medicaid was expanded under the Affordable Care Act.

That’s according to federal data released this week on those enrolled in Medicaid and the Children’s Health Insurance Program as of April 30.

The Charleston Gazette reports that nearly 154,000 West Virginians had enrolled in one of the programs since open enrollment began.

That makes for an increase of more than 43 percent in Medicaid and CHIP enrollment, the second largest of any state. Oregon saw enrollment increase by nearly 50 percent.

According to state figures, 508,496 West Virginians now have health insurance under one of the two programs. That’s more than a quarter of the state’s population.

Mass. Lab Settles W.Va. Health Care Fraud Case

  A Massachusetts clinical testing lab will pay the federal government more than $4 million to settle a health care fraud case in West Virginia.

U.S. Attorney Booth Goodwin announced the $4.67 million settlement with Calloway Laboratories, Inc. on Wednesday.

Goodwin says in a news release that an investigation found that Calloway Laboratories performed a medical review with urine drug screens that isn’t covered by Medicare or West Virginia’s Medicaid program. The company submitted claims for the review using a code for pathology services, which are covered.

Calloway Laboratories did not admit any liability in the settlement.

The company says in a statement that the settlement resolves a legacy issue that involved a disagreement about services that were ordered and performed, but weren’t covered. The issue dated back to previous management.

   

Health Care Glitch Affects 18,000 W.Va. Residents

  A state official says a glitch in the federal health insurance marketplace has affected about 18,000 West Virginians trying to sign up for coverage under the Affordable Care Act.

Jeremiah Samples of the state Department of Health and Human Resources tells the Charleston Gazette the federal exchange is having problems transferring account information to and from West Virginia’s system. He says some other states are having the same problem.

About 10,000 residents whose accounts should have been transferred because they’re eligible for Medicaid will have to sign up again, this time with the state. And about 8,000 residents who tried to sign up for Medicaid but were found to be ineligible now must go to the federal exchange if they want insurance because their information also was not transferred.

How Can You Protect Yourself from Medicare Fraud?

Open enrollment for Medicare ends Saturday, Dec. 7, and Kimberly Riddle with the WV Senior Medicare Patrol said that means an influx of scams directed toward seniors.

Whether they receive phones calls asking for personal information for fake Obamacare cards or banking information to bill them for their new Medicaid cards, Riddle said it’s important for seniors to know these are fraudulent calls and to report them.

At the West Virginia AARP’s “Consumer University” in Charleston, an educational seminar to reduce fraud among older West Virginians, Riddle presented easy steps for seniors to protect, detect and report possible healthcare fraud.

Protect:

Treat your Medicare, Medicaid and Social Security number like a credit card number, Never give these numbers to a stranger.

Remember, Medicare doesn’t call or visit to sell you anything,

Don’t carry your Medicare or Medicaid card unless you are going to a doctor’s appointment, visiting a hospital or clinic, or making a trip to the pharmacy.

Record your doctor visits, test and procedures in a personal health care journal or calendar.

Save your Medicare Summary Notices (MSN) and Part D Explanation of Benefits (EOB). Shred the documents when they are no longer useful.

Detect:

Always review your MSN and EOB for mistakes. You can access your current account 24 hours a day at www.MyMedicare.gov

Compare your MSN and EOB to your personal health care journal and prescription receipts.

Look for charges for something you didn’t get, billing for the same thing twice, or billings for services your doctor did not order.

Report:

If you have a question about the information on your MSN or EOB, call you provider or plan first.

If you are not comfortable calling your provider, call the Senior Medicare Patrol at 1-800-799-4638.

“If you do find a mistake you can call us and we’ll help you investigate that, answer your questions and see if we can’t get it resolved for you,” Riddle said.

For help reviewing your current Medicare plan and guidance on choosing the appropriate plan going into 2014, contact the West Virginia Bureau of Senior Services at 1-877-987-4463 or Medicare 24 hours a day at 1-800-633-4227.
 

60,000 More Residents Qualify for Medicaid

West Virginia Department of Health and Human Resources Cabinet Secretary Karen Bowling announced today that a second round of 61,000 auto-enrollment…

West Virginia Department of Health and Human Resources Cabinet Secretary Karen Bowling announced today that a second round of 61,000 auto-enrollment letters have been mailed to Supplemental Nutrition Assistance Program recipients and parents of children covered by Medicaid notifying them that they may automatically qualify for health insurance coverage.
 

To date, the DHHR has determined that 58,390 consumers are eligible for Medicaid expansion. 

The recipients of the second letter received a simple form asking if they wish to auto-enroll in Medicaid coverage.  A response is requested by December 18.
 
The Affordable Care Act of 2010 gave states, including West Virginia, the option to expand their Medicaid program to include individuals who were not previously eligible.  Governor Tomblin chose to expand Medicaid coverage.
 
Eligibility for Medicaid will depend on two factors: modified adjusted income and the size of the household.
 

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