Opinion :
The State Journal-Register | Springfield, IL
I write in response to The Associated Press story, “Questions about Illinois Medicaid cuts, pension reforms,” which states there is little evidence to support the claim that nearly 10 percent of Medicaid in Illinois and nationwide could be fraudulent. There is plenty of evidence to support my contention that nearly 10 percent of Medicaid payments may be inappropriate, at least that’s what a 2010 federal agency report says about Medicaid nationwide.
According to the U.S. Government Accountability Office, the federal Department of Health and Human Services calculated in its 2010 agency financial report that on the basis of individual state error rates from a sample of 17 states reviewed on a rotating basis each year, they estimate a national improper payment rate for Medicaid of 9.4 percent for fiscal year 2010.
The GAO report states improper payments to providers that submit inappropriate claims can result in substantial financial losses to states. The GAO says Medicaid payments can be improper for various reasons, such as if payments are made for people not eligible for Medicaid or made for services not provided.
A National Conference of State Legislatures report also estimates Medicaid fraud and abuse nationwide to be between 3 percent and 10 percent.
According to an NCSL brief for lawmakers in 2010, Medicaid expenditures for fraudulent claims cost states billions of dollars each year. In Florida, for example, Medicaid fraud accounts for between 5 percent and 20 percent of the Medicaid budget. Can you believe what it would be in Chicago or in Illinois with our history of mismanagement, cronyism and corruption?
Even the liberal New York Times estimates that 10 percent of Medicaid is fraud. Medicaid is our state’s largest expenditure — even more than education. A 10 percent savings equates to an astronomical $1.5 billion in savings. Eliminating fraud and specifically those ineligible recipients off our welfare rolls is not only the right thing to do, but helps ensure that those who truly need our care, primarily children and the elderly, get the assistance they need and that our providers are reimbursed in a timely fashion.
Unbelievably, in a cursory audit of just one Medicaid program (AllKids), the Illinois HHS director earlier this year admitted to some troubling findings when they mailed out monthly Medicaid cards. The agency discovered, incredibly, that nearly 6 percent of the mailings were returned as undeliverable with out-of-state addresses.
— Sen. Kirk W. Dillard, R-Hinsdale
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Tough decisions and votes required to save Medicaid
Illinois is facing a financial crisis that threatens the viability of the state’s Medicaid program, the health-care lifeline for the most vulnerable members of our society. For years now, Illinois has failed to adequately budget for the costs associated with this critical program that provides health care for low-income children, people with disabilities and seniors.
The nonpartisan Civic Federation reported that we must close a $2.7 billion budget gap in order to stabilize the program. If we fail, we will wind up with backlog of $21 billion in unpaid bills by 2017. This would devastate not only the Medicaid program, but the state’s health-care system as a whole.
In the face of this critical challenge, Gov. Pat Quinn has demonstrated leadership. The governor has proposed a balanced plan that combines cuts in spending, a rate cut for providers and a revenue increase in the form of a dollar-a-pack increase in the price of cigarettes. The cigarette tax is targeted to deliver both economic and health benefits. It would generate a dollar-for-dollar federal match of $337 million and reduce the long-term burden of smoking on the Medicaid system.
And it will shield providers from even steeper rate reductions than those we have proposed.
Unfortunately, some legislators have so far resisted the necessary steps to truly solve the state’s Medicaid crisis and save the system from collapse. They argue we can close the gap by tightening screening of applicants and beneficiaries. But that process is already well under way.
Anyone who thinks tighter eligibility screening will yield all the savings we need is not reckoning with reality. Tough decisions — and tough votes by the legislature — will be needed to pull the state out of the deep hole that we find ourselves in.
We sincerely hope that legislators from both parties will join us in taking a balanced, bipartisan approach to solving the Medicaid crisis. We can do this by enacting the tough but necessary measures that Gov. Quinn has proposed.
— Julie Hamos, director, Illinois Department of Healthcare and Family Service, Chicago
@ http://www.sj-r.com/opinions/x2138754267/Letters-Eliminating-fraud-is-a-key-to-reining-in-Medicaid-costs
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