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Advice for dealing with medicaid provider fraud

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sweetie

Member since 8/06

1730 total posts

Name:

Advice for dealing with medicaid provider fraud

So my dad has Healthfirst through NY medicaid & he just told me that the dentist he went to last week demanded $1100 cash before they would treat him....& he paid! Obvious fraud & I'm so mad they took advantage. the few reviews i found on yelp all describe this same situation.

My question is what can I do to get his money back? I plan on calling the office in the morning (they are beyond rude, btw) & i already have the Medicaid OIG fraud phone number.

Any advice would be appreciated!

Posted 1/22/16 12:47 AM
 
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Michelle1110
My family is complete

Member since 1/12

2338 total posts

Name:

Advice for dealing with medicaid provider fraud

I had a similar situation myself years ago. I threatened to call the insurance company and licensing board and report fraud, and then I sent them a copy of what I would be sending the news stations. They "duped" me for $1,000 while I was under anesthesia. After I sent them all those documents, I also showed up in the office and refused to leave until I got my money back. They said they were going to call the cops, so I dared them to. About an hour later I was written a check.

Eta: I did try being polite first and said there must have been a misunderstanding bc my insurance company said I never should have paid that, etc etc. that clearly did not work, so that's when I put the pressure on them.

Message edited 1/22/2016 6:46:28 AM.

Posted 1/22/16 6:44 AM
 

BargainMama
LIF Adult

Member since 5/09

15655 total posts

Name:

Re: Advice for dealing with medicaid provider fraud

If you don't mind PMing me the name of the dentist, I'm curious. I had an issue with one that took $1,100 from me....took a long time to get a refund. Not Medicaid related...but still curious

Posted 1/22/16 7:01 AM
 

sweetie

Member since 8/06

1730 total posts

Name:

Re: Advice for dealing with medicaid provider fraud

No need to pm...

Dental Specialists NY
94-38 59th Ave
Elmhurst

Posted 1/22/16 7:24 AM
 

sunnyplus3
:)

Member since 11/05

8749 total posts

Name:

Advice for dealing with medicaid provider fraud

I'm in the field, please continue to contact Medicaid but also reach out to the NYS office of Professions, that is the agency that handles enforcement. Additionally you can contact the NYS Dental Soceity. They will help you!

Posted 1/22/16 7:28 AM
 

sweetie

Member since 8/06

1730 total posts

Name:

Re: Advice for dealing with medicaid provider fraud

Thanks for all the advice! Should i contact the dental office 1st or just go through the other agencies?

Posted 1/22/16 9:20 AM
 

hcsf
LIF Adolescent

Member since 8/07

792 total posts

Name:

Re: Advice for dealing with medicaid provider fraud

I don't know much about dental insurance.

But is it possible that it isn't fraud?
1) Does the doctor participate with his insurance?
2) If he does participate is the service covered?

The dentist office usually always know how much you would be responsible for before the bill gets filed. And from my what I have seen in the past, they can ask for it up front.

Just because he has Medicaid doesn't mean that they can't ask for payment upfront if it isn't a covered service or if the doctor doesn't particiapte.

Posted 1/22/16 3:27 PM
 

sweetie

Member since 8/06

1730 total posts

Name:

Re: Advice for dealing with medicaid provider fraud

Posted by hcsf

I don't know much about dental insurance.

But is it possible that it isn't fraud?
1) Does the doctor participate with his insurance?
2) If he does participate is the service covered?

The dentist office usually always know how much you would be responsible for before the bill gets filed. And from my what I have seen in the past, they can ask for it up front.

Just because he has Medicaid doesn't mean that they can't ask for payment upfront if it isn't a covered service or if the doctor doesn't particiapte.



Well, the office is listed as a Medicaid provider & when I checked his coverage, tooth extraction is a covered service. They also didn't give him a printed bill, just a handwritten receipt & demanded cash only or he wouldn't be treated. It just seems so shady all around. I will definitely do more research. Thanks

Posted 1/22/16 6:03 PM
 

jessnbrian
Only God knows His plan for us

Member since 4/13

7238 total posts

Name:
Jessica

Re: Advice for dealing with medicaid provider fraud

Posted by sunnyplus3

I'm in the field, please continue to contact Medicaid but also reach out to the NYS office of Professions, that is the agency that handles enforcement. Additionally you can contact the NYS Dental Soceity. They will help you!



This! HOWEVER, there are many instances where doctors require deductible payment upfront prior to the rendering (or at the time of rendering) services. In this day and age it is entirely acceptable and appropriate for those purposes.

Posted 1/22/16 8:12 PM
 

Dream426
DD: July 11, 2011!!

Member since 6/08

1859 total posts

Name:
Gina Marie

Re: Advice for dealing with medicaid provider fraud

You need to contact his dental insurance and Medicaid. They are not allowed to charge him for services since he has Medicaid. They only can charge him if he signs something stating he is agreeing to paying for those specific services.

Posted 1/22/16 9:31 PM
 

Bridex100
Two Under Two Mommy

Member since 3/08

10420 total posts

Name:
Momx100

Re: Advice for dealing with medicaid provider fraud

Are you sure it is fraud? Dental work is so expensive these days. Could $1100 be his portion of the dental work?

I know my parents spend thousands of dollars on their teeth. My brother just recently got a tooth extracted and crowned and I think it cost $4000.

Posted 1/22/16 10:13 PM
 

Kris78
LIF Infant

Member since 10/11

120 total posts

Name:

Advice for dealing with medicaid provider fraud

That's a pretty strong accusation to make without having all the facts. I would delete the business information. It's not fair to them if they did nothing wrong. Jmo..

Posted 1/23/16 7:32 AM
 

TheDivaBrideandTeddyFrog
Leah's here!

Member since 9/07

5404 total posts

Name:
Sabrina

Advice for dealing with medicaid provider fraud

My dad recently had a similar issue and it was 100% fraudulent. Unfortunately I think it's more common than not

Posted 1/23/16 8:58 AM
 

sweetie

Member since 8/06

1730 total posts

Name:

Re: Advice for dealing with medicaid provider fraud

Posted by TheDivaBrideandTeddyFrog

My dad recently had a similar issue and it was 100% fraudulent. Unfortunately I think it's more common than not



Were you able to do anything about it?

I hear what other people are saying & i know dental work is expensive but medicaid should cover an extraction 100%. There are no deductibles or copayments & why would they demand cash & not give him a printed bill?

Posted 1/23/16 9:21 AM
 
 

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