State Medicaid Agencies Balk at Federal Funding for Data-Mining

January 27, 2016

By Jacob Vugrinac, Director of Business Development

“It is not enough that we do our best; sometimes we must do what is required.”
Winston Churchill

  • CMS released information on Medicaid’s sky-high improper payment rates
  • States won’t accept federal dollars to root out the errors
  • It is time for state Medicaid agencies to “do what is required” to stop the bleeding

CMS released information regarding improper payment rates … and to put it mildly they are not good.  Abysmal and horrid might be more apt in describing their effort and diligence.  The rate for improper payments skyrocketed from 5.8% or $14.4 billion in 2014 to 9.78% or $29.12 billion for fiscal year 2015.

For those of you keeping track, that increase is more than the GDP of Jamaica. Ya Man. No good.

Common sense would lead us to believe that states experiencing this increase in improper payments would be enraged and stop at nothing to resolve the issue. But this is the government we’re talking about here, so terms like “common sense” and “reasonable” should be used at your own peril.

Josh Devine, a spokesman for the Tennessee Bureau of Investigation stated, “We’ve yet to encounter a situation beyond (our Medicaid agency’s) capacity to provide timely information that would necessitate the extensive investment in personnel, infrastructure and equipment to essentially duplicate those resources.”

Contrary to data and common sense (oops I used that word again), many states believe their Medicaid agencies are doing an adequate job at generating leads for them to follow.  Any additional leads would likely cut into their Minesweeper and nap time.

The department of Health and Human Services has offered to use federal funding to undertake the data-mining that would put a stop to this drastic increase in errors. This funding would allow Medicare fraud units to delve deep into the issues that are causing this ridiculous increase and drive down the errors as the number of enrollees in Medicaid swells nationwide.

But the states say they do not need the help.  That’s like a drowning man saying thanks but no thanks to a life preserver.  And make no mistake about it, Medicaid is drowning.

As Churchill stated so eloquently, it is not enough to do your best if it does not get the job done.  It is time for state Medicaid agencies to accept the funding that is being offered and make the necessary changes to stop this madness.  It is time to stop the bleeding.  It is time to do what is required.

For questions or comments contact Jake at Vachette Pathology, 517-486-4262.

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