House advances Medicaid fraud program bill

Lawmakers advanced a bill Thursday that would put more stringent review efforts into detecting fraud by Medicaid recipients.

The bill by state Rep. Terry O'Donnell would let the state hire a private firm to review the financial records and other resources of Medicaid clients four times a year.

The goal is to verify the recipients' identities, and reevaluate their eligibility if anything happens that could change their status with SoonerCare.

The bill can't be brought up for a floor vote until lawmakers reconvene the special session. Even then, House and Senate leaders have said they will prioritize legislation

that addresses the $215 million budget shortfall.

Implementing the program would cost more than $1 million up front, plus an additional $50,000 each month in postage costs to notify Medicaid recipients of a status change.

Democrats criticized the bill in committee. State Rep. David Perryman, D-Chickasha, suggested that the bill wouldn’t meet the guidelines laid out by Gov. Mary Fallin in her special session executive order.

House Rules Committee Chairman Josh Cockroft, R-Wanette, said the bill falls under the request for lawmakers to find government efficiencies.

“How could that definition not apply to any legislation, if the ruling of the chair is being that broad in its interpretation?” Perryman asked.

Cockroft replied that the governor asked for efficiency in all areas of state government.

The legislation is identical to a bill that nearly made it through the Capitol this year in regular session. However, it did not garner enough support to reach a final vote. Three lawmakers filed a version of the “Act to Restore Hope, Opportunity and Prosperity for Everyone,” hoping for a hearing in special session.

O’Donnell, one of the three, said it is a misconception that someone in charge of reviewing a Medicaid client’s eligibility will be able to just throw the person off the rolls.

“They would have some reasonable basis for questioning eligibility before they do that,” O’Donnell said.

The bill also provides a multilayered review process. After informing recipients that their status may change, the recipients can attempt to justify it to the Oklahoma Health Care Authority.

If the authority is not convinced, the recipient would be allowed to ask the agency to investigate the case again.

Critics of the bill say Oklahoma already has measures in place to verify someone’s Medicaid eligibility. In other states where similar programs have been put into law, policy analysts say some Medicaid recipients are unfairly pushed out of the system when they don’t, or can’t, respond to inquiries.

Perryman said Thursday that lawmakers should focus on the other side of the federal health care program, saying the real waste and fraud isn’t among people who enroll in Medicaid.

“It’s the provider,” he said.