Wiki General Question

[lorrainewillis1@yahoo.com]

If a provider who takes Medicaid and sees adult patient's for adult ADD or ADHD charges the patient a cash price and then tries to charge their Medicaid. Do you all consider that double dipping?

 

[sls314]

If a provider who takes Medicaid and sees adult patient's for adult ADD or ADHD charges the patient a cash price and then tries to charge their Medicaid. Do you all consider that double dipping?

The provider should bill Medicaid in the first place, not collect payment from the Medicaid patient. What is the provider's rationale for collecting money from the patient before billing Medicaid?

Are the services not normally covered by Medicaid in that state? Without knowing the state and the specific services rendered, it is hard to give a specific answer.

The provider needs to make sure they are in compliance with the state's Medicaid regulations. If the provider receives payment from Medicaid for the services, then they will need to refund the patient's payment.

 

[lorrainewillis1@yahoo.com]

He says because he doesn't want to write to many adult add medicine so the patient has to pay for the service. State is Louisiana.

 

[csperoni]

I don't know Louisiana's Medicaid contract, but I have to imagine there is no way this is allowed. A provider is allowed to limit the scope of the patients they treat. For example, you can be a licensed obgyn, but only provide gyn services and not ob maternity services. The provider can decide for all patients that he does not manage adult ADD/ADHD and not treat those patients. A provider can provide services (like cosmetic for example) not covered under insurance and have patients pay for those services.
But he may not provide services covered under an insurance he is participating with and have the patient pay AND still bill the insurance on top of that. This is not coding, but rather compliance and contract driven, but certainly cannot be permitted.