NC Medicaid Providers: Believe only half of what you see and nothing that you hear

Edgar Allan Poe said, “Believe only half of what you see and nothing that you hear.”

Not only do I think that Poe’s quote is accurate in every day life, but even more accurate as applied to dealing with the Division of Medical Assistance (DMA).

A client told me a story: (This is a synopsis. This may not be a true story.)

“I called DMA Program Integrity (PI).  The person there told me that my documents were fine and that I should not worry.  Two days later, DMA sent me a letter terminating my Medicaid contract.  And guess who signed it? The exact person who reassured me over the phone!”

Obviously, this client was flabbergasted when the letter of termination was delivered.  I try to logically understand how “client” could be reassured one day by DMA and two days later be terminated from Medicaid by DMA.

My question is: Is there a lack of communication between or within departments at DMA?

Logically, I see two options. I have not come up with any other options, but feel free to suggest any.

Option A: Perhaps the signator does not actually sign the documents; instead, maybe there is a stamped-signature for the signator. So, if a stamped-signature is used, perhaps the signator was unaware of the Termination Notice being mailed. But if the signator was unaware of something as important as a Termination Notice, then there is HUGE breakdown in communication, either between departments or within departments at DMA.

Option B:  So, if there is NOT a lack of communication between departments or within departments at DMA, then I am left to logically ascertain that the signator knew that the Termination Notice was being mailed or was going to be mailed at the time of the reassurance to client.

 Both Option A and B are bothersome.  I actually cannot decide which one is worse.

However, despite the reason behind both: (1) the verbal reassurance; and (2) the termination notice, the moral of the story is obvious: “Believe only half of what you see and nothing that you hear.”

Furthermore, despite the reason behind both, the action to be taken from the moral is: Document everything.

It reminds me of Aesop’s Fable, “The Man and the Satyr.”

A man and a satyr once poured out libations together in token of a bond of alliance being formed between them. One very cold wintry day, as they talked together, the man put his fingers to his mouth and blew on them. On the satyr inquiring the reason of this, he told him that he did it to warm his hands, they were so cold. Later on in the day they sat down to eat, the food prepared being quite scalding. The man raised one of the dishes a little towards his mouth and blew in it. On the satyr again inquiring the reason of this, he said that he did it to cool the meat, it was so hot.

“I can no longer consider you as a friend,” said the Satyr, “a fellow who with the same breath blows hot and cold.”

Posted on May 1, 2013, in DHHS, Division of Medical Assistance, Health Care Providers and Services, Medicaid, Medicaid Audits, Medicaid Contracts, North Carolina, Prepayment Review, Program Integrity, Provider Medicaid Contracts, Termination of Medicaid Contract and tagged , , , , , . Bookmark the permalink. 3 Comments.

  1. Knicole,

    I don’t know if you have seen this video yet out of Wilmington. It involved a MD that took Medicaid who no longer is taking Medicaid due a PCG audit. It pretty much summed up what you have been dealing with. Slowly….slowly… the word is getting out about these horrible audits.

    http://www.wect.com/story/22120243/medicaid-fraud-crackdown-doctor-claims-his-innocence-stops-seeing-medicaid-patients

  2. Here was another video that the newscast did the other day on several other Medicaid providers. It looked like this news station cared nothing about due process, and innocent until proven guilty of these providers. Providers are going to stop taking Medicaid because of this mess. PCG is just asking to be sued for these horrible audits.

    http://www.wect.com/story/22106208/medicaid-fraud-crackdown-local-providers-under-review

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