Neighbors are really starting to get on my nerves

[Kanalua]

Link

Fraud And Abuse Hotline
1-800-533-0686
404-206-6480

To report anonymously by email
click here
now.

WHO WE ARE

As part of the General Counsel Division in Georgia?s Department of Community Health, the Program Integrity Unit identifies and pursues individuals and providers misusing or abusing the Medicaid, PeachCare and State Health Benefit Plan systems. Our primary goal is to identify and respond to fraud and abuse within the system, and to assist providers with education and corrective action.

We:

* Use the latest technology to detect and correct abuse and identify fraud;
* Maintain strong relationships with other state and federal agencies which also identify and prosecute fraud and abuse;
* Keep the lines of communication open with professional medical organizations to more easily identify providers who abuse Medicaid. We also coordinate efforts with our counterparts in the Southeast;
* Have developed a centralized information system that tracks cases from beginning to end;
* Strive for cost avoidance with corrective action, education and prevention.

The Program Integrity unit is focusing its efforts on the enforcement of policy and the verification of recipient eligibility.

WHY WE EXIST

Each dollar lost to theft or abuse is one less available for someone who really needs care. By stopping fraud and abuse and concentrating on cost avoidance, we help save tax dollars and ensure that valuable healthcare services will be available for eligible recipients in the future.

DEFINITION OF FRAUD

Fraud is an intentional deception or misrepresentation made by a person with the knowledge that it could result in some unauthorized benefit for himself or others. It includes any act that constitutes fraud under applicable federal or state law.

DEFINITION OF ABUSE

Abuse includes provider practices that are inconsistent with sound fiscal, business or medical practices, which result in unnecessary costs to the Medicaid program, or in reimbursement of services that are not medically necessary or that fail to meet professionally recognized standards for health care. Member practices that result in unnecessary costs to the Medicaid/Georgia Program or State Health Benefit Plan are also considered abuse.

TYPES OF FRAUD AND ABUSE

Examples of cases of fraud and abuse that the unit investigates include unreported income or insurance, Georgia recipients living out of state, drug-seeking behavior, incarceration, individuals receiving bills (or EOB statements) for services never provided, provider billing irregularities, over or under use of health care services and misrepresentation of credentials. Provider fraud could involve doctors, hospitals, nursing homes, home health, durable medical equipment, pharmacies, mental health facilities, laboratories, transportation and dentists. This list is not exhaustive.

WHAT IS IN IT FOR YOU?

The Program Integrity Unit, along with the Georgia Bureau of Investigation, Medicaid Fraud Control unit, Office of Inspector General, Federal Bureau of Investigation, Attorney General's Office, Department of Human Services, the State Health Benefit Plan and many other state and federal offices have recovered millions of health dollars. We provide our expertise, consultation and staff to all departments to help combat fraud, abuse and waste within Georgia.

Medicaid Recovery Efforts

 

[dquan97]

darn, if only you were in CA...I know friends in the "tax" business

 

[HardcoreRobot]

stop supporting socialism

 

[acemcmac]

Originally posted by: Kanalua
Link

Fraud And Abuse Hotline
1-800-533-0686
404-206-6480

To report anonymously by email
click here
now.

WHO WE ARE

As part of the General Counsel Division in Georgia?s Department of Community Health, the Program Integrity Unit identifies and pursues individuals and providers misusing or abusing the Medicaid, PeachCare and State Health Benefit Plan systems. Our primary goal is to identify and respond to fraud and abuse within the system, and to assist providers with education and corrective action.

We:

* Use the latest technology to detect and correct abuse and identify fraud;
* Maintain strong relationships with other state and federal agencies which also identify and prosecute fraud and abuse;
* Keep the lines of communication open with professional medical organizations to more easily identify providers who abuse Medicaid. We also coordinate efforts with our counterparts in the Southeast;
* Have developed a centralized information system that tracks cases from beginning to end;
* Strive for cost avoidance with corrective action, education and prevention.

The Program Integrity unit is focusing its efforts on the enforcement of policy and the verification of recipient eligibility.

WHY WE EXIST

Each dollar lost to theft or abuse is one less available for someone who really needs care. By stopping fraud and abuse and concentrating on cost avoidance, we help save tax dollars and ensure that valuable healthcare services will be available for eligible recipients in the future.

DEFINITION OF FRAUD

Fraud is an intentional deception or misrepresentation made by a person with the knowledge that it could result in some unauthorized benefit for himself or others. It includes any act that constitutes fraud under applicable federal or state law.

DEFINITION OF ABUSE

Abuse includes provider practices that are inconsistent with sound fiscal, business or medical practices, which result in unnecessary costs to the Medicaid program, or in reimbursement of services that are not medically necessary or that fail to meet professionally recognized standards for health care. Member practices that result in unnecessary costs to the Medicaid/Georgia Program or State Health Benefit Plan are also considered abuse.

TYPES OF FRAUD AND ABUSE

Examples of cases of fraud and abuse that the unit investigates include unreported income or insurance, Georgia recipients living out of state, drug-seeking behavior, incarceration, individuals receiving bills (or EOB statements) for services never provided, provider billing irregularities, over or under use of health care services and misrepresentation of credentials. Provider fraud could involve doctors, hospitals, nursing homes, home health, durable medical equipment, pharmacies, mental health facilities, laboratories, transportation and dentists. This list is not exhaustive.

WHAT IS IN IT FOR YOU?

The Program Integrity Unit, along with the Georgia Bureau of Investigation, Medicaid Fraud Control unit, Office of Inspector General, Federal Bureau of Investigation, Attorney General's Office, Department of Human Services, the State Health Benefit Plan and many other state and federal offices have recovered millions of health dollars. We provide our expertise, consultation and staff to all departments to help combat fraud, abuse and waste within Georgia.

Medicaid Recovery Efforts

Kanalua for elite

 

[Conky]

Reminds me of a song... :laugh:

If the wife and I are fussin', brother that's our right
'Cause me and that sweet woman's got a license to fight
Why don't you mind your own business
(Mind your own business)
'Cause if you mind your business, then you won't be mindin' mine.

 

[tk149]

IRS
more IRS

 

[desteffy]

stop complaining to us,

report them to the state!!!

 

[acemcmac]

Originally posted by: Slvrtg277

Originally posted by: Queasy

Originally posted by: Slvrtg277
I am definitely going on pure opinion based on what I've noticed around my area, but it seems to me that Democrats lean towards the "something-for-nothing, I deserve it even if I didn't work for it" programs/treatment far more than republicans.

This really has nothing to do with the existence of the "something-for-nothing" programs. It has to do with people taking advantage of the system and making others pay when they can afford their own healthcare.

I understand that. I originally asked the op what he was, based on my observations around here. If he turned out to be a democrat, I'd be wondering if he supported those types of programs that make some of the actions of his neighbors so easily possible.

It was all just curiosity.

The flaw with your suggestion is that labels don't work. Our presdident is a republican, and therefore should support giving more power to states and limmiting the federal government. Hipocracy is rampant on both sides.

 

[Geekbabe]

Our state offers medical insurance to those whom are self-employed or who work for an employer who doesn't offer insurance or when the offered coverage costs in excess of what the working family can afford.The insurance isn't free, premuims are based on income and there are also spend downs and co-pays required.

my health insurance plan, the cheapest one offered by my employer was $414 per month, it just went up to $460 per month and it's projected to go up yet again another 15% shortly.My wages are not increasing at anywhere near that rate. The newest and fastest growing group of uninsured people in this country are fully employed people.

Don't be so quick to judge.

 

[Phoenix86]

Hmm, where are all the "I don't snitch" posters?

I hate this kind of crap, which is why I'm for serious welfare reform. The current system has WAY too many holes, and only enourages people not working.

 

[NikPreviousAcct]

Originally posted by: Bozono
good thing they're not Mexican I guess





J/K

:laugh:

 

[PING]

They are not the only one, big corporation too. Walmart is doing the same thing. Guess who pays for their employees insurance...WE DO!

 

[waggy]

Originally posted by: PING
They are not the only one, big corporation too. Walmart is doing the same thing. Guess who pays for their employees insurance...WE DO!

hmm last i checked a business in not required by law ot give out isnurance. IF someone is working at walmart and does not have insurance i suggest they improve themselves so they can get a job that offers such stuff as insuarance.

but there is a reason why they work at walmart. usually because they do not have any skills that warrent them getting a job that will give them insurance.

again if they can't get a better job that is not walmarts or my problem.


As for the OP. report them. Welfare is for the trully needy. these people do not need it. if they can afford nice vehicles then let them pay for there own healthcare. I have worked my rear end off in college and work to be able to give my daughter good (not great) halthcare and everything she needs.

 

[MX2]

While I certainly agree that people who take advantage of our system need to be dealt with. I also feel minding your OWN DAMN BUSINESS is an issue here also.

No matter what happens in this situation, we that pay taxes and live "right" are always going to support things of this nature.

 

[ruffilb]

Originally posted by: OrByte
karma dude. Just keep your side of the street clean.

they will get what's coming to them...

Originally posted by: TBone48

Originally posted by: Malfeas
Don't be nice, do you duty as an honest taxpayer and report them. There are actual poor people who do need help, not these conartists.

Agree:thumbsup:

 

[Queasy]

Originally posted by: Geekbabe
my health insurance plan, the cheapest one offered by my employer was $414 per month, it just went up to $460 per month and it's projected to go up yet again another 15% shortly.My wages are not increasing at anywhere near that rate. The newest and fastest growing group of uninsured people in this country are fully employed people.

Don't be so quick to judge.

Neighbor 1 - 2005 Nissan Armada Styles
MSRP Price Range: $34,670 - $42,570
+
2005 Nissan Titan Styles
MSRP Price Range: $23,620 - $36,070
+
Harley

I think he could afford health insurance for just his children.

Neighbor 2 - 2005 BMW X3 Styles
MSRP Price Range: $30,995 - $36,995
+
BMW sedan (don't remember the model)

I think he can afford his own insurance as well.

 

[shortylickens]

Originally posted by: acemcmac
The flaw with your suggestion is that labels don't work. Our presdident is a republican, and therefore should support giving more power to states and limmiting the federal government. Hipocracy is rampant on both sides.

Well said.

I started voting for independants a long time ago because of this.
The two big guys spend more time pissing on each other than helping America.

 

[GTaudiophile]

Report 'em! Quite simple.

What bugs me are all the Americans who buy BMWs and Prada purses instead of paying for private school or saving for college.

 

[waggy]

Originally posted by: shortylickens

Originally posted by: acemcmac
The flaw with your suggestion is that labels don't work. Our presdident is a republican, and therefore should support giving more power to states and limmiting the federal government. Hipocracy is rampant on both sides.

Well said.

I started voting for independants a long time ago because of this.
The two big guys spend more time pissing on each other than helping America.

thats what ticks me off. IF the two big parties spent as much time helping the nation as they trying to pu ll down the other party this nation would be better off.

It ticks me off when something does not get passed just because the other party came up with it. WHO CARES!

I am getting sick of all politicians. they are all geedy worthless pigs.

 

[PingSpike]

Originally posted by: shortylickens

Originally posted by: acemcmac
The flaw with your suggestion is that labels don't work. Our presdident is a republican, and therefore should support giving more power to states and limmiting the federal government. Hipocracy is rampant on both sides.

Well said.

I started voting for independants a long time ago because of this.
The two big guys spend more time pissing on each other than helping America.

Thats not true, every once and awhile they take a time out from their bickering and work together to piss on America.

 

[FoBoT]

turn in the tax evasion crook now, he needs to go to jail

 

[BooGiMaN]

i have run into this numerous times..and yes it pisses me off too because my wife and i work hard to make a comfortable home for ourselves and our kids and this people seemingly are living a better life because they know how to work the system...

 

[Heisenberg]

I would say you should make a couple of anonymous phone calls to the IRS and welfare office.

 

[Queasy]

Holy Thread Resurrection Batman! LOL

 

[ITJunkie]

Originally posted by: PingSpike

Originally posted by: shortylickens

Originally posted by: acemcmac
The flaw with your suggestion is that labels don't work. Our presdident is a republican, and therefore should support giving more power to states and limmiting the federal government. Hipocracy is rampant on both sides.

Well said.

I started voting for independants a long time ago because of this.
The two big guys spend more time pissing on each other than helping America.

Thats not true, every once and awhile they take a time out from their bickering and work together to piss on America.

:laugh: