Michigan has been forced to adopt a policy to stop Medicaid fraud under the provisions of the Patient Protection and Affordable Care Act (aka Obamacare) and Small Business Jobs Act.
With Michigan's contractual arms twisted behind its back, here are the proposed policies to force Michigan to end Medicaid fraud, even in child welfare.
The only concern I have is to question if there is a referral process to the State Attorney General Medicaid Fraud Control Unit (MFCU). If there is, how is it there is to be review of questionable billing claims in child welfare when the State Attorney General is obligated to advocate for the ones who are generating the questionable billing. If, in the miraculous event, there is successful identification of questionable and/or improper billing, will these contracted child welfare organizations have license revoked or be contractually debarred and published on the public sanction list.
In addition, regarding the predictive modeling, will the state set up any form of dispute resolution function for providers, mainly dental providers, who will experience the extreme financial burden of having Medicaid reimbursements suspended during the investigative process and incur substantial legal fees challenging situations like medical coding.
Lastly, there needs to be addressed the Medicaid reimbursement disparities of dental services in regions known to have high concentrations of economic distress. Some have purported findings that these disparities in Medicaid dental rates to be racially charged based upon demographic data but greatly I enjoy elevating disputes from the realms of an ad hominem and call it what it is.
The Medicaid dental disparities of rates is subject to further examination. Stay tuned.
Michigan Medicaid Claim Predictive Modeling Policy
Michigan Medicaid Sanction Provider Notification Process Policy
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