Se­na­tors de­mand crack­down on Med­i­caid waste

The Washington Times Weekly - - Politics - BY JAMES VARNEY

The fed­eral gov­ern­ment has gone more than 25 years with­out mak­ing a se­ri­ous ef­fort to re­cover over­pay­ments for bo­gus Med­i­caid charges that could run into the bil­lions of dol­lars, ac­cord­ing to two se­na­tors de­mand­ing an ex­pla­na­tion.

Sens. Chuck Grass­ley, Iowa Re­pub­li­can and chair­man of the Fi­nance Com­mit­tee, and Pa­trick J. Toomey, Penn­syl­va­nia Re­pub­li­can and chair­man of the health sub­com­mit­tee, said they were stunned by a re­cent re­port by Louisiana’s au­di­tor that found a large por­tion of Med­i­caid ben­e­fi­cia­ries weren’t el­i­gi­ble for at least part of the time they were col­lect­ing ben­e­fits.

“Un­for­tu­nately, gov­ern­men­tal ef­forts to en­sure Med­i­caid pay­ments are spent pru­dently have fallen short,” the se­na­tors said.

Med­i­caid is the fed­eral-state part­ner­ship to pro­vide health cov­er­age for the poor.

States run their pro­grams, but the fed­eral gov­ern­ment foots part of the bill.

The law was dra­mat­i­cally ex­panded by Oba­macare, and that has swollen the ranks and fed the prob­lem, the se­na­tors said in their let­ter to Seema Verma, ad­min­is­tra­tor of the Cen­ters for Medi­care and Med­i­caid Ser­vices.

Some states are re­port­ing that high per­cent­ages of peo­ple en­rolled in Medi­care un­der the re­laxed rules of Oba­macare should have been ruled in­el­i­gi­ble.

“We’re thrilled they are look­ing at it be­cause it’s a huge prob­lem, one of the ma­jor scams hap­pen­ing in wel­fare pro­grams to­day,” said Sam Adolph­sen, a vice pres­i­dent at the Foun­da­tion for Gov­ern­ment Ac­count­abil­ity. “In­el­i­gi­ble peo­ple swelling the rolls is tak­ing away re­sources from the very peo­ple Med­i­caid is sup­posed to help.”

Oba­macare made the prob­lem worse by al­low­ing states to re­view and purge their Med­i­caid lists of in­el­i­gi­ble ben­e­fi­cia­ries only once a year, Mr. Adolph­sen said.

“Es­sen­tially, the Obama ad­min­is­tra­tion was telling states to forgo the pro­gram’s in­tegrity in a rush to boost its num­bers,” he said.

While of­fi­cials said there have been some in­di­ca­tions that CMS and the Trump ad­min­is­tra­tion are in­ter­ested in work­ing with the se­na­tors on the prob­lem, CMS de­clined to dis­cuss the mat­ter, say­ing it would re­spond to the se­na­tors di­rectly.

In the up­com­ing 2020 bud­get, the depart­ment has re­quested more money to im­prove CMS’s abil­ity to re­coup im­proper Med­i­caid pay­ments.

CMS, in its bud­get pre­sen­ta­tion, blamed “cur­rent law and reg­u­la­tions” for lim­it­ing the agency’s abil­ity to re­cover over­pay­ments. It pro­posed claw­back author­ity be­yond the cur­rent im­proper pay­ment struc­ture.

There is some con­cern on the Hill that while CMS wants to ap­pear se­ri­ous about com­bat­ing Med­i­caid fraud, not enough of its ef­forts are di­rected to­ward im­proper ben­e­fi­cia­ries.

Con­se­quently, the se­na­tors asked Ms. Verma to de­tail any ef­forts CMS has made since 1992 to re­cover over­pay­ments and to pro­vide in­for­ma­tion on the er­ro­neous pay­ment rates of in­di­vid­ual states.

It wasn’t im­me­di­ately clear why fed­eral of­fi­cials have not acted be­fore, though the se­na­tors said there ap­peared to be a de­ci­sion more than 20 years ago to fo­cus “on prospec­tive im­prove­ments in el­i­gi­bil­ity de­ter­mi­na­tions rather than dis­al­lowances.”

The fed­eral gov­ern­ment must take the lead in polic­ing in­el­i­gi­bil­ity and over­pay­ments be­cause a per­verse in­cen­tive struc­ture gives states lit­tle rea­son to do, the se­na­tors said.

That’s be­cause Wash­ing­ton picks up much of the tab for reg­u­lar Med­i­caid and al­most all of the bill for those added un­der Oba­macare.

They pointed to re­cent state stud­ies of new ben­e­fi­cia­ries that de­tected a range of in­el­i­gi­ble par­tic­i­pants, from 7 per­cent in Ken­tucky to be­tween 25 and 30 per­cent in Cal­i­for­nia and New York, to “an as­tound­ing 82 per­cent” in a ran­dom sam­ple se­lected in Louisiana, the se­na­tors note.

The se­na­tors told Ms. Verma that they would like to work with CMS ei­ther in ramp­ing up en­force­ment ef­forts or pro­vid­ing the agency with new le­gal tools for claw­ing back mis­spent dol­lars.

“Our of­fices would like to work with you on our shared goal of en­sur­ing that the gov­ern­ment com­plies with the in­tent and plain lan­guage of … the So­cial Se­cu­rity Act by dis­cour­ag­ing sys­tem­atic and rou­tine er­rors in Med­i­caid el­i­gi­bil­ity de­ter­mi­na­tions by states,” the se­na­tors wrote. “We be­lieve that CMS’ past ac­tions have ig­nored its re­quire­ments un­der the law.”

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