Boxcarbill or IAAL

[ktarra617]

What is the name of your state? Tx

I have a question. A few weeks back my daughter mentioned that she had been to the dr over her christmas break with her father and that she had been given some medicine.

I called her father and asked why I was not told about the dr visit and the medicine that she had been given. He told me he forgot about it. When I asked him what she had been taken their for, he said well she had an ear infection and they gave her zithromax.

I asked why I hadn't recieved a receipt from him for my half of the visit and the medicine. He said well the doc just looked her over when we took the other kids up there for their appts. So he never officially saw my daughter. Which his kids are on medicaid so I don't know if he billed medicaid extra for seeing my daughter or not.

But here's the part that concerned me is that the medicine he prescribed was presribed for my daughter under one of her brother's name so that medicaid would pay for it and my ex didn't have to pay the 20.00 co-pay that is required by my insurance. (He has an insurance card for our insurance that we provide)

I am afraid that by not reporting this I will be seen as condoning his behavior and in a way aiding it. To me that is fraud to get the medication prescribed under one childs name to avoid co-pays with the intention of giving to another one.

Should I report this and do I have any liability here because I know about it?

 

[Boxcarbill]

So your question is whether you should report the doctor for prescribing a controlled substance under another person's name and being a party to the offense of fraud?

 

[ktarra617]

yes, that is my question.

 

[ktarra617]

bump

 

[Grandma B]

If you didn't know about the prescription at the time she was taking it, how do you know under whose name it was ordered?

 

[ktarra617]

in our conversation which is on tape he told me that the doctor gave her the medicine but put in one of the boys names since he wasn't billing them for seeing her. They didn't want to have to pay the co-pays. So by putting it in one of the boys name medicaid paid for it. I can't even get him to pay his half of the co-pays so I damn sure know that he didn't use our insurance to get the prescription. Besides I called my insurance company and they verified that no prescriptions were billed to them for that time period.

This is the same guy that thinks since he doesn't want to afford to re-imburse me for her health insurance that he should be able to put her on medicaid since he's court ordered to provide the health insurance.

Basically he wants the taxpayers to pay for him and his children as much as possible.

But he told me and its all on tape that the doc prescribed her the meds in one of brothers name. All I am concerned with is that I don't get seen as aiding him. I know that they don't go after a lot of medicaid fraud. Especially one as small an amount as this particular incident is.

I just don't want my rear in a sling if you get my point.

Thanks!

 

[Boxcarbill]

in our conversation which is on tape he told me that the doctor gave her the medicine but put in one of the boys names since he wasn't billing them for seeing her. They didn't want to have to pay the co-pays. So by putting it in one of the boys name medicaid paid for it. I can't even get him to pay his half of the co-pays so I damn sure know that he didn't use our insurance to get the prescription. Besides I called my insurance company and they verified that no prescriptions were billed to them for that time period.

This is the same guy that thinks since he doesn't want to afford to re-imburse me for her health insurance that he should be able to put her on medicaid since he's court ordered to provide the health insurance.

Basically he wants the taxpayers to pay for him and his children as much as possible.

But he told me and its all on tape that the doc prescribed her the meds in one of brothers name. All I am concerned with is that I don't get seen as aiding him. I know that they don't go after a lot of medicaid fraud. Especially one as small an amount as this particular incident is.

I just don't want my rear in a sling if you get my point.

Thanks!

This is entirely your call. Someone is going to have to report fraud for anyone to even have a possibility of "being in a sling." Then the medicaid is going to have to decide whether the allegation merits looking into. Then whether the case, even if true, merits pursuit in terms of costs of trial. Expect that if all this were to come to pass that the doctor is entitled to confront and cross-examine his accuser. Also I would not count on the doctor stipulating to the truth of the recorded conversation between you and your ex.

 

[Boxcarbill]

This is the same guy that thinks since he doesn't want to afford to re-imburse me for her health insurance that he should be able to put her on medicaid since he's court ordered to provide the health insurance.

Basically he wants the taxpayers to pay for him and his children as much as possible.

Merely as a sidebar: In Texas, if health insurance were not available through the obligor's employer or the obligee's employer or if insurance were unavailable to either parent at a reasonable cost , the court could order the obligee or the obligor, to the extent provided by law, to make application for the child to be enrolled in a medical assistance program under Chapter 32, Human Resources Code, or the state child health plan under Chapter 62, Health and Safety Code and for the obligor to reimburse the obligee for the cost of participation in the program.

 

[ktarra617]

I kinda figured it would end up being my word against his, I just didn't want to get any fingers pointed at me since I knew he was doing this.

As to the medicaid thing, I understand that if no insurance were available to me through my employment (Which I am a housewife, my insurance is through my husband's employment) and none is available to my ex, or obtainable at a reasonable cost then the court could order that we apply for the state health care plan, correct?

I would not mind doing that if my husband didn't already provide my daughter's health insurance, and two) we already divide the premium by the number of children on the plan and only bill him 55.00 a month for her insurance. That is not an unreasonable amount for monthly health insurance in my opinion. I could be wrong.

The other problem is that my husband makes way too much money for state aid. He pays out close to 600 a month for his cs plus health insurance and half the costs. Sooo..I couldn't qualify anyway, or can a judge rule that be allowed to enroll her on state insurance regardless of my income?

Thanks for your answers, I am learning a lot!

 

[Boxcarbill]

As to the medicaid thing, I understand that if no insurance were available to me through my employment (Which I am a housewife, my insurance is through my husband's employment) and none is available to my ex, or obtainable at a reasonable cost then the court could order that we apply for the state health care plan, correct?

I would not mind doing that if my husband didn't already provide my daughter's health insurance, and two) we already divide the premium by the number of children on the plan and only bill him 55.00 a month for her insurance. That is not an unreasonable amount for monthly health insurance in my opinion. I could be wrong.

The other problem is that my husband makes way too much money for state aid. He pays out close to 600 a month for his cs plus health insurance and half the costs. Sooo..I couldn't qualify anyway, or can a judge rule that be allowed to enroll her on state insurance regardless of my income?

Thanks for your answers, I am learning a lot!

My comment regarding state aid was merely as a sidebar comment to make the point that the obligor still doesn't get a free ride at taxpayer expense. No, the priority of health care coverage in Texas is like I side above and in that order of preference.

 

[ktarra617]

I understand.

Thank you!

 

[mamadi]

ktarra617??? got a question for ya

I may have misunderstood everything you were saying but I have a question for you or for anyone who can answer since were kind of on the subject of insurance. My husband's ex is required to pay $56 per month in child support to us for her two children. She is also required to pay for medical which hasn't happened yet. She may not even be qualified to recieve medical through work (department store ??). Is there any way she could be required to reinburse my husband for the insurance coverage in which he pays for the children each week ($40 per week) since she may not be able to get the required insurance ??

Diane

 

[Boxcarbill]

Re: ktarra617??? got a question for ya

I may have misunderstood everything you were saying but I have a question for you or for anyone who can answer since were kind of on the subject of insurance. My husband's ex is required to pay $56 per month in child support to us for her two children. She is also required to pay for medical which hasn't happened yet. She may not even be qualified to recieve medical through work (department store ??). Is there any way she could be required to reinburse my husband for the insurance coverage in which he pays for the children each week ($40 per week) since she may not be able to get the required insurance ??

Diane

Diane, you need to start a "new message" for your question regarding health care for children in NC.