Improper Billing of Duals
Improper billing (also sometimes referred to as “balance billing”) occurs when doctors, hospitals, or other providers charge beneficiaries with both Medicaid and Medicare for co-pays, co-insurance, or deductibles.
Patients who have both Medicaid and Medicare (including Medicare Advantage) should never be charged for services covered under Medicaid or Medicare. Billing for covered services is illegal under both federal and state law.
As more and more dual eligible patients move to managed care plans, improper and illegal billing may increase due to doctor & hospital confusion. Justice in Aging wants to make sure patients are protected. In 2011 we authored a policy paper on the need to improve protections for dual eligibles, Improving the Qualified Medicare Benefit for Dual Eligibles. In early 2017 we released a new issue brief, Fighting Improper Billing of Dual Eligibles: New Strategies and created a toolkit to provide advocates with resources to help their clients who are being improperly billed. See our toolkit of resources in the tabbed sections below.