AboutAdelaide Rose Expertise Any questions related to Revenue Cycle Management and homecare/facilities operation processes.
Experience I have been in the healthcare industry since 1992. My experience comes from working in a multi-physician practice setting, homecare, ambulatory care and consulting engagements with a "Big 5" firm.
Question I am divorced and provide health insurance coverage for my children through my employer. My ex has recently obtained medicaid for our children because she is unemployed. My children have recently received benefits through medicaid for dental and medical. I believe she is committing fraud because she is not using my insurance first and then the medicaid to cover the portion that my insurance does not cover. I do not want to defraud the government or get into any trouble. Am I correct about this issue.
Answer Bryan,
If your children are covered under your insurance, then your insurance is primary. Mediaid is always deemed to be the last payer of resort. You are correct, the primary insurance should be billed first and if a there's a balance after that then Medicaid should be billed.
If and when Medicaid finds out about the primary coverage, they may request all payments back from the providers and then the primary insurance will have to be billed.
The problem then is, if your insurance doesn't pay due to timely filing or if you have a referral requirement which was not met; because obviously you (ex-wife) was ignoring this primary coverage and didn't get the proper insurance referrals, you may end up having an issue.
