NC Medicaid, in cooperation with its partners and the NC Attorney General’s fraud Medicaid Investigations Division (MID), has identified that some beneficiaries dually eligible for Medicare and Medicaid who reside in long-term care facilities have had their flex benefit cards misused.
- If representative payees receive flex benefit cards on behalf of dual eligible special needs plan members, that payee is obligated to maintain an account for the member’s flex cards.
- Representative payees and members are prohibited from comingling the flex card funds with other patient care funds.
- The flex card is only allowed to be used exclusively for the member’s individual needs.
NC Medicaid encourages Medicare Advantage Organizations who partner with the Medicaid program as a Dual Special Need Plan carrier to perform periodic audits of the flex cards to ensure compliance and mitigate the risk of financial exploitation.
With effective monitoring of members' utilization of the flex benefits cards, NC Medicaid and the MID can ensure the benefits assigned to dually-eligible beneficiaries are used as intended for the benefit of the Medicare Advantage member by the beneficiaries.
Contact
Third-Party Recovery, 919-527-7690