MEDICAID

Medicaid

Medicaid

Introduction

The financing of health care in the United States is part public, part private; part national health insurance through Medicare, Medicaid, and several other government—sponsored programs; part employer sponsored; and increasingly individually purchased through private-pay insurance plans and out-of-pocket payments from consumers. It is a complex system that, for all the wealth it consumes and creates in the United States, still has left almost 20% of the population with no coverage and many more with far too little coverage. Under the health reform legislation of 2010, many of the uninsured will receive health care coverage through an expanded Medicaid program or under the requirement that everyone purchase insurance. For those who do not meet the poverty guidelines for the expanded Medicaid coverage, an insurance exchange will be available through which they will be able to find affordable coverage (Imperato, 2003).

The main aim of the Medicaid program is to provide people with financial assistance who cannot afford medical care and to achieve this aim; the government is finding ways to reduce the fraud transactions that are taking place and causing a hindrance in providing medical care to the needy. The government has revised Medicaid laws so that people who need this facility can avail it.

False Claims Act

Medicaid is a governmental program. False claims act (FCA) is a law that imposes liability on the people who defraud this government program. Third party consultants are the main culprits. Third party consultants who participate in the Medicaid program are the ones who commit frauds. There is a huge risk involved in the establishing relationships with third party consultants, but this does not mean that relationships should not be established. The Medicaid people should take utmost care in establishing contractual relationships and should conduct a thorough research before contracting any party (Welch, 2006).

Medicaid providers should look into ethical considerations before establishing relationships, and should also look into their history so as to identify their involvement in any illegal activity. The promises and guarantees posed by the consultant should be investigated by the providers so that they have an idea about the consultant.

If any mishap occurs, not only will the third party will be liable, but also the provider will be equally liable. Keeping in mind the risk of being liable, the providers should monitor the relationship very closely, and if they find any suspicious activity, they can report it to the court directly. Submission of false ...