Dual Eligibles for Medicare, Medicaid come under fire

 

Michael Arrigo expert witness in Federal State and Civil Courts on ACA, HIPAA, Healthcare costs in malpractice and personal injury, False Claims Act cases involving Medicare Advantage and Electronic Health Records
Michael Arrigo expert witness in Federal State and Civil Courts on ACA, HIPAA, Healthcare costs in malpractice and personal injury, False Claims Act cases involving Medicare Advantage and Electronic Health Records.  CONTACT

Dual Eligibles for Medicare, Medicaid cost too much.

 

The administration that created the Patient Protection and Affordable Care Act with Medicaid expansion as a centerpiece to cover more low-income insureds is now sending out letters notifying people who have policies via health insurance exchanges to end them immediately . So called “dual eligibles” are costing too much, and now the government seeks to end the subsidies associated with them.  Under Medicaid Expansion, those at a certain percentage above the Federal Poverty Level (FP), usually 133% to 138% are eligible for Medicaid, which covers 100% of their medical bills so long as an insured patient gets their healthcare via a Medicaid approved doctor or other health care provider.  Insurance on the Exchanges, though subsidized, does not cover all insurance expenses but does cap annual out of pocket expenses.  The effect of a household qualifying for Medicaid as well as subsidies for health insurance under the ACA is, in our opinion an overinsurance and over spend loophole that should be closed. Impact for future cost of care: those who have insurance under Medicaid stand to continue to have all health care costs covered.

Related Posts
Medicaid Expansion

Michael Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, stutdies at Harvard Law School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims).
Loading Facebook Comments ...

Leave a Reply