Every year, the FBI monitors industry fraud trends, and for the past decade or so, more and more cases of home care financial fraud have been reported. While all health care programs are subject to fraud, the most popular are Medicare and Medicaid. Each year, millions of dollars from these programs are paid to home health care companies for services that either weren’t necessary or were never provided.
At New Generations, our Home Care and Adult Day Care programs are created to help those in need continue fulfilling their life. Our Home Care program gives elderly and disabled individuals the option to be assisted in the comfort of their own home, while our Adult Day Care program allows them to interact and socialize with others at our facility.
Studies show that 70% of seniors who are 65 years old will need some long-term care assistance and 30% will require care for more than 5 years. This responsibility is overwhelmingly assumed by family members such as children and spouses. Even with good family support, many will need additional assistance from professional caregivers to care for their loved ones.
When it comes to Medicare, there are some patients (labeled dual eligibles) who qualify for a Medicare Savings Program or qualify for Medicaid benefits. These dual eligibles can usually take advantage of the Qualified Medicare Beneficiary benefits and be paid first by Medicare, then have the remainder paid by Medicaid.
In recent weeks, the South Carolina Department of Health and Human Services has been working with interested parties to explore ways to more efficiently manage our state’s Medicaid program. The agency and work groups are specifically debating how to address the needs of a growing population of elderly and disabled with a dwindling revenue stream.