They care for hundreds of thousands of people in Hawaii, but some doctors who take Medicaid patients use the safety net insurance as a prescription for profit.
Part of understanding the impact of Medicaid fraud is understanding just how big it is. It’s that safety net insurance that covers for the poorest in our communities even some of our middle income families.
It’s one of the single biggest expenses in the Department of Human Services that comes from federal money, in billions of dollars, so even if there’s a little bit of fraud it can be millions of dollars of misspent money.
So how are those few dishonest doctors caught, and what happens when they are?
It’s a lot easier these days to try and track anomolies than it used to be thanks to technology.
The Department of Human Services, the attorney general, even the private companies that administer the insurance watch for anomolies in the codes, such as if there are certain things being billed too much, are people being billed for an hour of service, did they really get it, or were they even there?
They see some patterns, flag it and red flag it and start to look into that.
What was discovered is that some doctors who are caught doing this sometimes still get to practice medicine. Others get caught in what very well might be an honest mistake and sometimes feel put through the ringer as though they were guilty.
Always Investigating is looking into all of this, including what’s being done to stop Medicaid fraud, and to make sure that when they do crack down it’s being applied fairly to all concerned.
All that is coming up on the KHON2 News at 10 in the full report Monday night.