Medicaid fraud has risen and bogus payments have more than doubled since Obamacare expanded the government’s chief health insurance program for the poor, topping $37 billion a year, according to a new report released Wednesday by the Senate’s chief watchdog committee.
The Centers for Medicare and Medicaid Services (CMS), which oversees the program, doesn’t even have an anti-fraud strategy, and has ignored 11 separate recommendations by the Government Accountability Office over the last three years to combat fraud, the Republicans said on the Homeland Security and Governmental Affairs Committee said.
California alone paid out $1 billion in sketchy payments, yet the Centers for Medicare and Medicaid Services (CMS), which oversees the program, told Congress it didn’t see any urgency in trying to go after the money.
Making efforts to collect that money should be a start for CMS, said the GOP staffers, in a report issued by committee Chairman Ron Johnson, Wisconsin Republican.
“CMS is not effectively policing Medicaid fraud,” the committee’s Republican staff said in the new report, blaming program directors going back more than a decade.
The massive Medicaid program is also feeding the opioid epidemic, Mr. Johnson says, by serving as a source for illicitly obtained drugs.
Medicaid is the federal-state partnership to provide health coverage for the poor. Created as part of the Great Society programs of the 1960s, it has steadily increased in size to cover 70 million people at a cost of $554 billion a year — most of that from federal taxpayers.
The program saw a major expansion under Obamacare, with the federal government trying to entice more poor people to sign up by expanding eligibility to families that make above 100 percent of the poverty level. Most states have signed on board the expansion, accepting a generous federal match in exchange for promising to pick up more of the tab themselves in the future.
But the program’s ability to fight fraud hasn’t kept up.
Improper payments soared from $14.4 billion in 2013, the year before the expansion, to $37 billion in 2017. Medicaid now accounts for 26 percent of all improper payments in the federal government.
And the actual rate could be even higher, the GAO has warned.
Some of the steps CMS has yet to take are basic.
States are responsible for determining if people are eligible, and that creates an opening for bad payments since CMS doesn’t do a comprehensive audit of those decisions.
Illinois may have paid Medicaid benefits for people whose immigration status hadn’t been verified, while New York wrongly calculated benefits for more than 30 percent of its enrollees, the committee said, pointing to watchdog reports.
Mr. Johnson has prodded CMS to explain the fraud and bogus payments. The program’s administrator said they disallowed $15 million — a level of less than four one-hundredths of a percent of the total $37 billion in bogus payments.
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