Make Believe Insurance Coverage?

Duaine

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100+ Post Club
The HPE Determination Process: A Hypothetical Example




To illustrate how the HPE determination process might work in practice, following is a fictional account of an


uninsured patient during a hospital visit:




Oscar is a 42yearold landscaper. Single and without children, he earns about $15,000 per year, and has






never had health insurance. He strained his back helping a friend move a broken refrigerator. After three


days of intense pain, Oscar decided to go to the emergency department (ED) at a local hospital.


In the ED, a hospital employee, Mary, gives Oscar a brochure explaining how the Affordable Care Act has


allowed their state to expand Medicaid for single adults ages 18 to 64 with annual incomes under




$16,105.iv Mary tells Oscar that she may be able to enroll him in Medicaid temporarily and help him apply






for permanent coverage. She asks Oscar for basic information, including his legal name, address, date of




birth, social security number, and his weekly takehome pay. She then logs into an online hospital PE


applicationv provided by the state Medicaid agency and enters Oscar’s information, except his social


security number, which Oscar doesn’t remember.vi Mary quickly verifies that Oscar is not enrolled in






Medicaid, and determines that he is presumptively eligible for Medicaid.


Mary prints a temporary Medicaid eligibility card for Oscar. She also prints a checklist of information he’ll




need to provide to complete the full online Medicaid application, and schedules a followup call with him






to finish the application. With temporary card in hand, Oscar goes back to the ED admit desk and gives his


new health insurance information. After seeing a doctor, Oscar takes his prescription for muscle relaxants


to a local pharmacy, where he uses his temporary Medicaid card to pay for the prescription. A few days


later, Oscar gets a call from Mary, and with her help, finishes his full Medicaid application online.






This story demonstrates how the HPE process can help an uninsured individual pay for immediate care at a


hospital and help connect the individual to long-term, stable health insurance coverage.






https://www.statereforum.org/system/files/hpe_fact_sheet_021114.pdf
 
What a crock! Why even bother enrolling for free insurance when it will be paid for at the last minute anyway.
 
Step one: Obtain temp Medicaid card from Mary with fake info (no social? No proof of income? No proof of residence or citizenship? No real data or verification whatsoever.)
Step two: Use it
Step three: A few days later, Mary calls a fake number. Repeat as needed with a new name and a new fake number next time.

I can't see it going any other way. Yes, some will legitimately just sign up for Medicaid. Everyone else just has to lie to "Mary" so they presume you're eligible in order to get free care.

They'll learn real quick how to game that system.
 
Step one: Obtain temp Medicaid card from Mary with fake info (no social? No proof of income? No proof of residence or citizenship? No real data or verification whatsoever.)
Step two: Use it
Step three: A few days later, Mary calls a fake number. Repeat as needed with a new name and a new fake number next time.

I can't see it going any other way. Yes, some will legitimately just sign up for Medicaid. Everyone else just has to lie to "Mary" so they presume you're eligible in order to get free care.

They'll learn real quick how to game that system.



Its not really free care, however. If you are found ineligible for medicaid, guess what, hospital will still come after you for the cost of care......You could make the argument that it is gaming the system in order to access treatment, but EMTALA generally allows access..
 
Come after the fake patient, with a fake number/address/social?

I'm sure "Mr. Bill D. Bear at 123 Stuffing Lane, Bearville 12345" is shaking in fear of being found. (Shocklingly, he wasn't already on Medicaid, the only "check" they mention in the description.)

Even if they do find the scammer, you really think they have a snowball's chance in hell of collecting from a low income, lying, no bank account, no tax filing, system gaming scumbag?

The point I was trying to make, is this offers an opportunity to acquire free care and prescriptions with fake information, with no verification or reporting. As we know, people abuse the system, and this has a massive potential for abuse if they don't verify income/citizenship/identity.
 
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