Instead, they accept the long waits for care in drop-in clinics and emergency rooms. However, as states move parents on welfare into the workforce, they will need to develop skills working people use in seeking medical care. This includes setting appointments to get care from PCPs. Medicaid Fraud and Abuse. The FFS Medicaid program has lots of opportunities for fraud and abuse because no one is closely watching how services are provided.
States can identify major cases of fraud and abuse.
But, a FFS program does not have the ability to catch minor cases. A minority of Medicaid recipients avoid HMO enrollment because it is more difficult to abuse HMO care than FFS Medicaid. Most states are now moving toward mandatory HMO enrollment for Medicaid recipients. Most use the savings from having more Medicaid recipients in HMOs to pay for choice counseling by enrollment brokers. Please contact us with any questions or comments.