Medicaid for therapy..just when you think you've seen it all...

Discussion in 'General Parenting' started by OTE, Jan 11, 2007.

  1. OTE

    OTE Active Member

    My youngest, my Pervasive Developmental Disorder (PDD) kid has been in speech therapy from diagnosis. Since 02 it's only been in school. As he's on SSI and Medicaid the school can bill Medicaid for this speech therapy. Just when I thought I'd heard and seen it all.... two men show up at my door today. They're "financial investigators" from the Medicaid Investigations Unit of the state Attorney General's office.... aka guys who look for Medicaid fraud. They are investigating my son. LOL. Now I know he has not used Medicaid any more than a physical and dental checkups so I'm not worried. They're accusing the school district of Medicaid fraud! They want to know if he got speech therapy every week as he should have. They want to know if I have a log or other record of when he got this therapy! I assure them that I am clueless, always the last to know. So they're going to call back next week and see if I can dig up anything like quarterly progress reports (the only thing I stand a chance of having). They sure are desperate for something from me. But they're only interested in the 05/06 school yr.

    So I call his current teacher. She says she can't talk about it but "all compensatory therapy" was done a long time ago and they thought this was over. Also, that my son was never involved in this. I explained that it's not an educational/ IEP/ IDEA issue, it's Medicaid fraud! She reminded me that one of the 2 speech therapists at that school quit last yr and they had "temp" speech therapist for the rest of the school yr... like 6 mo.

    They're at my door because all the school district gave them was my name and address, No phone numbers!

    Now keep in mind that this is 2 in the afternoon and I'm in the long underwear I slept in last night with an armful of laundry when I answer the door. I was actually thinking it was the fire dept since there was a ridiculous amt of smoke coming from my apt as I gave up trying to clean my oven and was just letting whatever grease was on the bottom burn off so I could cook at turkey. I'm not TOO embarrassed... NOT! So I excuse myself to throw on a robe to spend a half hour outside of my smokey apt in the cold talking to these poor guys. Guess I looked like I was a Medicaid recipient who is not employed anyway... good to be when Medicaid fraud people show up at your house. LOL

    Just when I thought I'd heard it all! Medicaid fraud by my school district! LOL
  2. dreamer

    dreamer New Member

    I know we had my kids at dentists under Medicaide who supposedly did work they did not do and billed medicaide for it..more than once.
    I know our school district did bill medicaide for some thngs for my kids...but- I think they did at least appear to be doing what they billed for------BUT I personally never saw a bill, statement or anything, and never got a benefits statement from anyone showing what had been billed or paid for.

    Very interesting!
  3. Liahona

    Liahona Active Member

    I watched the Speech Language Pathologist (SLP) at the school fill out lots of forms for medicaid. It was incredable. Maybe the temp Speech Language Pathologist (SLP) didn't fill out all the right forms? How funny.

    I'm glad someone else is still in pjs at 2 pm. I might be normal in one aspect of my life.
  4. Marguerite

    Marguerite Active Member

    I wouldn't worry too much about how you looked - it sounds to me like they have wither the school district or the Speech Language Pathologist (SLP) in their sights, not you. They just want you to produce paperwork (or not) that they can use to either demonstrate that what has been signed for has actually happened; or to track down someone who has been rorting the system (I trust 'rort' is in the US slang dictionary also).

    Sounds to me like the Speech Language Pathologist (SLP) may have been claiming payment from Medicaid for work that she may not have done - naughty, naughty! And the victim in this, besides Medicaid - your son, because he's not been given the therapy that Medicaid have paid for. That is, if there has been fraud.

    So in this case, it sounds like they would be on your side.

    And these guys would see lots of people with smoky kitchens and in long underwear. The difference with you - you acted like you were embarrassed by it. It's the people who expect you to see this as normal, who would be a worry.

  5. Star*

    Star* call 911

    OHHHHHHHHH they could be monitoring your board posts!!!!! I am NEVER paranoid...OHhhhhhhhhh. :wildone:

    Good grief.....did you offer them your toothbrush for DNA? (Falls on floor from seeing too many CSI episodes)

    Ah....say B....what WERE you wearing BEFORE you put on that robe? * Huh? Did it Look Expensive? Oops....maybe i won't say anymore since "they" are monitoring your emails and posts. Sorry....


    Not signing my name to THIS one.....yeah that will show them. :cool:
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member arent in Trust me on this one.

    The medicaid fraud folks from the state do this from time to time when billing appears out of the realm of normal. We used to get calls from clients who got EOB's saying that they had work done that they never had. Or the state would notice that the same client would 8 wisdom teeth pulled...Uhhh NOT! Some is provider fraud some is client fraud.

    I could write a book. Maybe I should...I could get rich. LOL.
  7. OTE

    OTE Active Member

    OK, just for clarification purposes...LOL...I rarely get to sleep before 2 or 3 in the a.m. I get up at 7 to get the kids out. Get back to sleep after 9 and then sleep till midday while the house is empty. If I'm then not going out, doing chores, lately it's ripping up carpet, I don't shower and dress until the dirty work is done. I was sorting laundry when they knocked on the door. The attire was a pair of Xmas long underwear from Hanna Andersson with nothing underneath. Yes, long underwear. Not my best look, particularly when things sag at my age, but it's comfortable. The robe covered everything. LOL. And neither one of them was young so I'm sure they've seen it all.

    But which embarrassed me more, the fact that horrible smelling smoke was billowing out the patio doors or I looked like crap I don't know.

    Talked later that night to another mother of a relatively moderate functioning autistic kid I know. She's in the same position I've been in since the school district has a very low functioning autism class and mainstream after K. Hers is going into K. So she's struggling with what to do. They're thinking about moving back to NJ just to get an autism program for that child. Her other two are barely pre-school so moving isn't a big issue for her.

    Her and her husband are spending their lives arguing for this child's education. She told me she was recently in the ER for her first time ever cardiac issue due to stress from this. They have gone to the highest guy with the school district and the School Board and have gotten the director of Special Education (who has a 35 yr career behind her) demoted so that no parents will ever again have to deal with her. She's stay at home mom with 3 young kids but she's devoting her life to this. She argues about every therapy appointment, every interaction her child has with other kids, it's really unbelievable. She's gotten articles published in the local paper numerous times about this. She's currently pushing the local paper to do another article so I told her I'd be happy to give her the State guy's name for them. LOL Oh yes, the autism program is horrible and I have no problem with who knows that.
  8. Marguerite

    Marguerite Active Member

    On the one hand, your friend would probably do better if she moves to where there's a better program. on the other hand, everyone in your area would do better if she stays.

    Wow! I like her already, a woman after my own heart! Shame about the stress reaction, though. If she's going to continue as a Warrior Mum, she needs to find ways to help herself reduce stress. She needs to do this for her kids as much as for herself.

    Star, I had to laugh about the paranoia bit. The trouble is, I have had to BECOME paranoid, because I HAVE been stalked online. That's why I use a pseudonym.

    Mind you, the people most likely to want to have a go at me for posting things like, "Your autism program is horrible? At least you HAVE one!" are the ones who haven't got the skills or the energy to find me if I'm using a pseudonym. [Besides, we now DO have an autism program of sorts, although it is still very limited.]

    It sounds ridiculous, but it does happen. I have had things I've written on education-related issues under my own name turn up at the local school being handed round the staff. Things get 'lifted' and passed around. The rules of writing mean that I SHOULD have been asked when an article of mine originally submitted to a small support network magazine was re-published in a book dealing with Gifted & Talented Education, so at least I would have known. In that article I had criticised (but not named) the local school. I had even quoted them. As a result, my name was mud for a while. And I suspect that ever since then, despite favourable articles written since, every so often their computer tech person does a search on my name to see what I'm up to. Anything found would be passed on up the line, to provide ammunition for the next time I try to make waves.

    It happens. They also know I'm working on a book of our experiences of the education system and how to get around the problems. I have friends in the system but I also have some big enemies who would love to see me nobbled.

    Some paranoia can be justified. If it makes us appropriately cautious, it's good. If it cripples us with anxiety, it's bad. We need to put in some balance. If we're feeling paranoid, we need to think - what do THEY want from me? Is there anything I've been doing which would upset them? Sometimes the very people we're fearing can be there to help us, or who need our help.

    A lot of people in Australia are nervous of the Tax Department. Our tax system has been simplified to the point where our tax return forms say, "How much did you earn last year? How much do you have left? Send it in." Well, not quite. But the rules keep changing, sometimes retrospectively. When trying to fill out your tax form to make sure you can claim as many deductions as possible, the last people you would want to ring would be the Tax Department. But in fact, they are the first who are the most helpful. They WILL help us claim deductions. Instead of thinking, "Don't ring them! Don't tip them off that you're thinking about trying to cut back on your tax expenditure!" it's a matter of recognising that our Tax department are raking it in by the billions. They can afford to be helpful and generous. They KNOW that EVERYBODY will try to cut back on their tax bill and will do their utmost to help you do it legally.
    So for us, anxiety about the Tax Department is unwarranted, unless you KNOW you fiddled the books. THEN paranoia is justified, because they ARE out to get you.
    But if the Tax Department contacts you to find out if you really did pay your accountant $60,000 then don't feel nervous. You're both on the same side.

    OTE, I'm dying to know how this pans out. WAS the Speech Language Pathologist (SLP) fiddling the books?