GAO: $14 billion in improper Medicaid payments

The Government Accountability Office has released a shocking report on Medicaid waste. They found that $14 billion had been improperly paid to managed care organizations (MCO's) who work with state Medicaid agencies to service eligible clients.

Washington Examiner:

The "size and diversity" of the MCOs have put both state and federal governments at odds on how to oversee the payments, the report said.

Specifically, the wrong payments made were for treatments or services not covered, not necessary, or billed for but never provided, GAO found.

States that expand Medicaid programs under Obamacare will receive a 100 percent reimbursement from the federal government for MCOs for the next two years, the report said.

Given that state and federal governments have recovered "only a small portion" of the wrongly paid money, unless they ramp up their oversight of MCOs, even more Medicare dollars will be "vulnerable to improper payments," GAO said.

States were also under-reporting to the federal Centers for Medicare and Medicaid how much money they recovered when they realized they'd made these undeserved payments, GAO revealed.

In 2013 alone, Medicaid covered almost 72 million Americans. The program costs American taxpayers more than $430 billion annually.

Just how bad is Medicaid fraud, waste, and abuse? Liberals dismiss the claims of massive problems with Medicaid, but the facts say otherwise.

An independent audit of Medicaid recipients by the state of Illinois last year should chill a prudent taxpayer to the bones:

In January, the Illinois Department of Healthcare and Family Services, or HFS, began a new project verifying eligibility for Illinois’ 2.7 million Medicaid enrollees. For years, state workers had failed to take adequate steps to ensure the people receiving Medicaid benefits were actually eligible for the program. As an Auditor General report noted, state workers failed to verify basic eligibility criteria, such as income, residency and citizenship status. Worse yet, some of the annual eligibility checks had been delayed for more than five years.

So state lawmakers pushed HFS to hire an independent vendor who specializes in this kind of work to review Medicaid eligibility. Since January, the independent vendor has reviewed nearly 419,000 case files of individuals currently enrolled in Medicaid. Of those, the vendor identified more than 210,000 that were ineligible for benefits, which amounts to more than 50 percent of all cases reviewed so far. Another 47,000 cases reviewed so far this year were eligible for some benefits, but enrolled in the wrong program. For example, some individuals enrolled in Medicaid may only qualify for programs with greater cost-sharing. Overall, the review has yielded an eligibility error rate of more than 61 percent.

When HFS receives a recommendation from Maximus to cancel benefits for a particular case, the state gives the enrollee an additional 20 days to submit documentation showing they are still eligible for benefits. The state then removes individuals from the program after verifying that they are no longer eligible.

Unfortunately, the American Federation of State, Municipal and County Employees has initiated a legal challenge which may slow or halt this progress. AFSCME wants the state to terminate its contract with the expert vendor reviewing eligibility and instead hire new dues-paying state workers to do the job. Never mind the fact that state workers’ failure to do the job adequately prompted the state to hire an independent vendor in the first place. With another 347,000 cases currently pending review, and thousands more on the way, this challenge becomes all the more worrisome.

Eventually, the auditor found that fully half of the 700,000 + Medicaid beneficiaries investigated were ineligible for benefits or receiving an improper amount of benefits.

And that's from one state.

So, on top of this broken program, the Obama administration is adding about 7 million new recipients. Most of those 7 million will be using MCO's for their health care needs.

What could go wrong?

 

The Government Accountability Office has released a shocking report on Medicaid waste. They found that $14 billion had been improperly paid to managed care organizations (MCO's) who work with state Medicaid agencies to service eligible clients.

Washington Examiner:

The "size and diversity" of the MCOs have put both state and federal governments at odds on how to oversee the payments, the report said.

Specifically, the wrong payments made were for treatments or services not covered, not necessary, or billed for but never provided, GAO found.

States that expand Medicaid programs under Obamacare will receive a 100 percent reimbursement from the federal government for MCOs for the next two years, the report said.

Given that state and federal governments have recovered "only a small portion" of the wrongly paid money, unless they ramp up their oversight of MCOs, even more Medicare dollars will be "vulnerable to improper payments," GAO said.

States were also under-reporting to the federal Centers for Medicare and Medicaid how much money they recovered when they realized they'd made these undeserved payments, GAO revealed.

In 2013 alone, Medicaid covered almost 72 million Americans. The program costs American taxpayers more than $430 billion annually.

Just how bad is Medicaid fraud, waste, and abuse? Liberals dismiss the claims of massive problems with Medicaid, but the facts say otherwise.

An independent audit of Medicaid recipients by the state of Illinois last year should chill a prudent taxpayer to the bones:

In January, the Illinois Department of Healthcare and Family Services, or HFS, began a new project verifying eligibility for Illinois’ 2.7 million Medicaid enrollees. For years, state workers had failed to take adequate steps to ensure the people receiving Medicaid benefits were actually eligible for the program. As an Auditor General report noted, state workers failed to verify basic eligibility criteria, such as income, residency and citizenship status. Worse yet, some of the annual eligibility checks had been delayed for more than five years.

So state lawmakers pushed HFS to hire an independent vendor who specializes in this kind of work to review Medicaid eligibility. Since January, the independent vendor has reviewed nearly 419,000 case files of individuals currently enrolled in Medicaid. Of those, the vendor identified more than 210,000 that were ineligible for benefits, which amounts to more than 50 percent of all cases reviewed so far. Another 47,000 cases reviewed so far this year were eligible for some benefits, but enrolled in the wrong program. For example, some individuals enrolled in Medicaid may only qualify for programs with greater cost-sharing. Overall, the review has yielded an eligibility error rate of more than 61 percent.

When HFS receives a recommendation from Maximus to cancel benefits for a particular case, the state gives the enrollee an additional 20 days to submit documentation showing they are still eligible for benefits. The state then removes individuals from the program after verifying that they are no longer eligible.

Unfortunately, the American Federation of State, Municipal and County Employees has initiated a legal challenge which may slow or halt this progress. AFSCME wants the state to terminate its contract with the expert vendor reviewing eligibility and instead hire new dues-paying state workers to do the job. Never mind the fact that state workers’ failure to do the job adequately prompted the state to hire an independent vendor in the first place. With another 347,000 cases currently pending review, and thousands more on the way, this challenge becomes all the more worrisome.

Eventually, the auditor found that fully half of the 700,000 + Medicaid beneficiaries investigated were ineligible for benefits or receiving an improper amount of benefits.

And that's from one state.

So, on top of this broken program, the Obama administration is adding about 7 million new recipients. Most of those 7 million will be using MCO's for their health care needs.

What could go wrong?

 

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