NC Health Care Providers Who Accept Medicaid: Thank you!

How about a big “Thank you” to our North Carolina health care providers accepting Medicaid?

Many providers continue to accept Medicaid despite the fact that the state is conducting Medicaid audits, the providers feel harassed by the state, the providers are terrified that they have to pay back hundreds of thousands of dollars for health care services actually rendered to Medicaid recipients, the providers are forced to wait months post-services rendered to receive Medicaid reimbursements, and the reimbursements are so much lower than the overhead costs.

Why?  Why do health care providers undergo so much emotional and financial strain to provide health care services to Medicaid recipients?  I believe that health care providers who dedicate services to Medicaid recipients truly understand and believe that the Medicaid population deserves and needs quality health care.  These providers understand that most providers will not undergo the mental and financial stress needed to meet all the Medicaid criteria and documentation. So these providers feel a sense of duty to Medicaid recipients.

And to those health care providers who accept Medicaid in NC: “Thank you.”

I heard a story today of a health care provider who deserves this “Thank you,” and more. When the Personal Care Services (PCS) criteria changed this past January 1, 2013, many of the provider’s clients no longer qualified to receive PCS under Medicaid.  Did that stop the provider from providing the needed PCS?  No.  Is the provider paid for its services?  No.  But this provider was dedicated to its clientele.

So when 80-year-old Dorothy (obviously, I have changed the names), who suffers from late-stage breast cancer, dementia, and Rheumatoid arthritis was told that she no longer met the PCS criteria, she was terrified.  But this provider continues, even today, to provide Dorothy the care she needs.

The provider is not reimbursed for helping Dorothy.  But the provider feels a sense of duty.  Do you turn your back on someone in need because the General Assembly changed the PCS requirements?  Or do you continue to help the person you have cared for for so many years and hope that the government will somehow right the injustice?

Interestingly, this same provider is undergoing two Medicaid audits for a total of approximately half a million in alleged recoupments.  The provider was forced to hire an attorney and defend the Medicaid reimbursements it has received for years of providing quality health care service to the Medicaid population.  Instead of getting a “Thank you,” the state has audited and claimed that the provider must pay back almost half a million dollars, even though the provider provided all the services for which it billed.

Yet this provider, not only provides all the services for which it bills Medicaid, but when Medicaid drops Dorothy (and thousands of others) from the Medicaid program, this provider goes above and beyond its call of duty and provides services knowing that Medicaid will never reimburse it.

Maybe this provider should not be audited. Maybe the Medicaid system should be audited for all the services for which this provider is not paid.  Or maybe  this provider, and many others, deserve a simple:”Thank you.”

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on February 21, 2013, in Congress, Group Homes, Health Care Providers and Services, Legislation, Medicaid, Medicaid Eligibility, Medicaid Recipients, Medicaid Recoupment, Medicaid Reimbursement, North Carolina, Personal Care Services and tagged , , , , , , , . Bookmark the permalink. 4 Comments.

  1. Yes, but how much more such harassment will this provider and other providers tolerate? What will happen to their patients once they “throw in the towel”?

    “Enquiring minds want to know.”

    • Spot on, Ed. This particular provider already expressed thoughts of no longer providing PCS for Medicaid recipients. As to other providers? No idea where the threshold lies.

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