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IN 1993, ATTORNEY GENERAL JANET RENO DECLARED HEALTH-CARE fraud the 'number two crime problem in America' after violent crime--a remarkable status for a category of white-collar crime. In 1995, FBI [...]

Purpose: This study examines whether the relationship between making familial wealth transfers and becoming a Medicaid recipient sheds light on the current debate about Medicaid estate planning, whereby some elders transfer their assets to their families to qualify for Medicaid. Design and Methods: Using the Health and Retirement Study, we tracked a national sample of community-based elders who did not receive Medicaid at the 1993 baseline interview but became Medicaid recipients during a 10-year time period and examined wealth transfers for these new Medicaid beneficiaries. Results: Among elders aged 70 or older who did not receive Medicaid in 1993, 16.4% became Medicaid recipients over 10 years. Among these new Medicaid recipients, 17.9% transferred their wealth to family members before receiving Medicaid benefits, with an average transfer amount of $8,507 during the 2 years prior to receiving Medicaid benefits. In addition, 15.2% of community-residing elders entered a nursing home during the l O-year period, and 26.3% of these were covered by Medicaid. Of these new Medicaid recipients living in nursing homes, 12.6% transferred wealth to their families in the mean amount of $4,112. Implications: Familial wealth transfers do occur before changes in Medicaid eligibility in a small, but nontrivial, number of cases, but the amount transferred is modest, especially among nursing home residents. This finding implies that policies to reduce Medicaid long-term-care expenditures by limiting such transfers may not be very effective. Key Words: Medicaid, Medicaid estate planning, Family wealth transfer, Private transfer, Crowding out

The Medicaid program was enacted in 1965 for the purpose of providing federal cost sharing in the payment for medical services for the indigent. Although there are major differences among the states in eligibility criteria and benefits, the federal law requires that benefits include payment for long-term care services. The article notes that certain provisions of the law enable middle-class individuals to transfer assets and to use other means of qualifying for Medicaid. These practices, especially Medicaid estate planning, enable middle-class persons to retain their assets in their families rather than 'spending down' to qualify for Medicaid benefits. This article argues that these practices constitute a form of legal welfare fraud. The reality of the long-term care provisions of the Medicaid program can be seen as backfiring in ways that undermine the intended purpose of the program and that have negative consequences for the general social good. Keywords: Medicaid estate planning; financing long-term care; asset transfer; long-term care insurance

Dentists must be aware of the different types of fraud so they can prevent it from happening in their office. It is estimated that 10% to 15% of national health care expenditures are lost to fraud. Fraud in medicine usually arises from improper billing. Billing mistakes can be accidental, so investigators usually focus on those that appear to be intentional. Types of fraud include billing for services not actually rendered, billing for services more expensive than those that were actually rendered, waiving co-payments, and providing un-proven treatments.

Health-care reform, a major cornerstone in President Clinton's agenda, looked like a certain crowd pleaser. Americans consistently rated the delivery of medical services in their country as highly unsatisfactory, though, [...]