How does the Medicaid system work?

timer Asked: Nov 7th, 2015
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Question Description

How does the Medicaid system work?  At what point does an individual apply?

Tutor Answer

School: Purdue University

Thank you for the opportunity to help you with your question!

Medicaid is a system that  provides medical advantages for people who can’t afford otherwise. And it’s set up in a program where the federal government invests money to the program as to each of the states and it’s typically a 50-50 split, (Jim,2012). The type of Medicaid cases that can be  dealt with initially are dual eligible cases where an individual was receiving medical benefits through a medical insurer and at the same time eligible for Medicaid, so there were two payers in that respect. And the question is then who should pay what? And the law was basically Medicaid should be the payer of last resort and pay only after the medical insurer had fully paid what’s due under their policy. Well, it turned out that under the billing processes for these big companies, CVS and Walgreen’s, they were doing it just the opposite(Linden,2012). They were billing Medicaid first and then the private insurer secondly so Medicaid ended up paying more money, substantially more money that it should have. So that basically is the Medicaid fraud case there.

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awesome work thanks

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