Is it legal for someone receiving insurance through a major provider to receive Medicaid, too?
Friday, September 3rd, 2010 at
10:48 pm
My stepdaughter is covered on my insurance, which is a major carrier. However, there are copays, which her birth mother does not want to pay (she chooses not to work). So she applied for, and received, Medicaid and another type of state insurance on my stepdaughter. Now my stepdaughter is covered by a major carrier (through me), and 2 types of state insurance. Isn’t this insurance fraud?
My stepdaughter is not disabled, but she has to see a doctor routinely for diabetes.
Filed under: Retirement Planning
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Yes, it is legal. It’s also quite common, if someone has a disability (like ADHD, or Down’s Syndrome).
As long as Medicaid knows there’s a second policy in place, there is no fraud.
It’s fraud if Medicaid wasn’t informed that she was covered by another insurance. However, there are circumstances when a person can have a private insurer as primary insurance and Medicaid as secondary insurance. Individuals with disabilities have this type of coverage frequently, if they are also of low-income.
If Medicaid is not informed about the other insurance, that is Medicaid fraud.
Chances are very high that this is Medicaid fraud. If your insurance coverage is good, there is no reason for your stepdaughter to have additional coverage. You are advised to contact the local agency which has provided and approved Medicaid to insure that they are aware of the coverage which you provide. I’m guessing that they are NOT aware.
It is legal for her to be covered by both insurance plans.
However, Medicaid is always the secondary payor. (Payor of last resort.)
Your health insurance plan would have to pay first, and then Medicaid could pick up the copays or any remaining patient liability.
If she’s not using your insurance at all and just going through Medicaid, that’s a problem. Medicaid will go back even years later and recoup payments for Coordination of Benefits issues if they find out that a member had other primary coverage.
She’ll save herself a lot of hassle if she follows proper procedure and uses Medicaid as secondary coverage. They still won’t have to pay any copays, because the remainder will be taken care of by Medicaid. (Either Medicaid would pay, or the provider would be forced to write them off because the commercial insurance paid more than Medicaid would have allowed.)
No, it is not illegal. It is very common. My son is covered through his father’s insurance (we are not together), but when I got laid off from my job, I had to apply for medicaid and they required me to put my son down on the application, so he is also covered even though we have his father’s insurance coverage. I thought it was strange as well, but medicaid said that it was standard procedure.