The Wall Street Journal: A Medicaid Fraud Check-Up

The Wall Street Journal: A Medicaid Fraud Check-Up

WASHINGTON, D.C. - The Wall Street Journal Editorial Board highlighted serious failures by states to follow basic Obamacare safeguards, thereby allowing waste, fraud, and abuse to persist in Medicaid while taxpayers foot the bill. Despite clear federal requirements to regularly revalidate providers, many states are failing to perform even routine oversight, leaving the program vulnerable to bad actors.

WORD ON THE STREET

From the Wall Street Journal:

"The Trump Administration last week ordered states to review the qualifications of their Medicaid providers in an effort to clamp down on fraud. Good idea, because states aren't doing the equivalent of a basic routine physical on providers, according to new data from the Foundation for Government Accountability (FGA).

"ObamaCare requires states to revalidate all of their Medicaid providers at least once every five years… This can help screen for such red flags as a lapsed license.

"States are also required to check a federal blacklist of providers that committed crimes, gross negligence, fraud or patient abuse… In Minnesota, some Medicaid autism treatment centers, transportation providers and housing purveyors were shams.

"Ditto hundreds of hospices in California… more than 150 licensed hospice and home health agencies were licensed at a single building in Los Angeles. One hospice medical director was affiliated with more than 30 hospices, which is suspicious.

"Yet few states are complying with this ObamaCare mandate… those that have are falling far short.

"Some 58,306 of Illinois's (26%) providers haven't been revalidated in five years… Georgia has revalidated only 11.4% of its providers in the last year… Ditto Michigan.

"The feds foot on average 70% of states' Medicaid bills, totalling $700 billion this year. States have no excuse for not performing routine check-ups on providers.

"'Classes of providers with less rigorous enrollment and billing requirements' are 'most vulnerable to fraud'… revalidating providers could 'deter criminal actors from continuing their fraud schemes.'

"The fundamental problem is that states have little incentive to police fraud… because they get more federal funds the more they spend."

THE BOTTOM LINE

States are failing to carry out basic oversight, even as taxpayers spend hundreds of billions of dollars to fund the Medicaid program. Improvement starts with accountability-enforcing existing safeguards, strengthening oversight, and fixing the perverse incentives that reward higher spending without improving outcomes. Without it, fraud will continue to drain resources from the vulnerable Americans Medicaid is meant to serve.