I currently live in Wisconsin, and before that I had spent most of my time on the East Coast. I needed only look at the date on the calendar yesterday, and I knew the drill.
Yesterday (obviously) was St. Patrick’s Day. In Ireland, this is considered a serious day for the mostly Catholic country. In America, thanks to the descendants of the rabble from Europe having come to our shores, it’s an excuse to drink (a lot).
It is with great sadness, and to the significant financial detriment of the Wisconsin Tavern League, that I must announce that I was at home this St. Patrick’s Day, as my wife is out of town and I am in charge of my 6-year-old for the time being. As a public service, I would like to offer the reader a flimsy excuse to continue overindulging.
I have been spending a lot of my free time considering the expansion of Medicaid, set to arrive on January 1st, 2014 as part of the ongoing implementation of the Patient Protection and Affordable Care Act. Of late, I have written about the counter-intuitive approach of rolling out the Medicaid RAC program at full speed as millions are about to be added to states’ Medicaid rosters. One infrequently discussed portion of the Medicaid universe that I would like to turn my attention toward is Medicaid State Fraud Control Units (SFCUs).
Back on March 4th, the OIG released the results for SFCUs nationwide from Fiscal Year 2012. The final number is impressive on its face, showing over $2.9 billion in recoveries. Most of the states with bigger recoveries also ended up being our most populous states, which didn’t come as a surprise, but I decided on my own to conduct another exercise for purposes of self-enjoyment.
If we overlay the individual state collections by SFCUs over a map of states that have thus far decided against Medicaid expansion under PPACA (by the latest count there are 14 states in the “definitely not” column), we find that over $1.4 billion of the collections (or 48% of the total) comes exclusively from those same 14 states.
To me this points to another weakness in the Medicaid expansion. Thanks to the Supreme Court decision that gave the green light to PPACA, expanding Medicaid is now optional for all states. At first, those states more vocally opposed to the law quickly stated that they would not expand Medicaid programs in their states. Slowly, some of those original states, such as New Jersey and Florida (thought the Sunshine State has yet to finalize participation) have changed their minds, mainly due to hospitals – which have no interest seeing a spike in uncompensated care – lobbying in these states.
Medicaid Integrity programs are several years behind similar efforts in the Medicare system, mainly because in attempting to control the costs of Medicaid, you are forced into dealing with 50 different audit philosophies. Standardization does not exist, so it becomes any one’s guess as to what will be audited and when.
Obviously, the states involved in turning down a Medicaid expansion are doing it for political purposes, but is it a significant leap to say that the Medicaid Fraud in these same states is so pronounced that expanding the program would overwhelm their ability to control fraud? I leave that up to the reader, but it hands these states some ammunition beyond a simple disdain for all things Barack Obama.
My wife comes home today. See you at the bar!