Crackdown urged on Medicaid fraud

Health policy analysts yesterday suggested clamping down on Medicaid fraud and abuse to offset expected cuts to the federal health care program for the needy.

“We sometimes are paying for people who should be paying for themselves; many people assign property and assets to their children and then start using Medicaid,” said Dr. Louis W. Sullivan, a panelist at a Medicaid forum hosted by the Joint Center for Political and Economic Studies and the American Public Health Association.

The panelists, who expect Congress to cut Medicaid funding over the next several years, recommended ways to contain program spending, such as capping eligibility, covered services and reimbursement.

They also suggested linking federal reimbursement to states with economic performance. During a recession, for example, states could expect a greater reimbursement.

“We would like to have more flexibility to let us do more. I just hope we don’t lose sight of what’s important,” said Dr. Warren A. Jones, executive director of the Mississippi division of Medicaid.

Several states are working to cap the number of Medicaid enrollments in a given year, but the federal government has been slow to respond to cultural and economic factors, the panelists said.

Dr. Jones said one program designed to get people off Medicaid rolls, using reverse adjustable mortgages to pay for long-term care, isn’t attractive to patients. Reverse adjustable mortgages allow older consumers to convert a portion of the equity in their homes into cash from a lender, but the lender then assumes control of the remaining equity.

“What we find in the African-American community is that land is the last thing they want to put in jeopardy; so it may work, but it is not a culturally sensitive plan,” Dr. Jones said.

Fiscal conservatives in Congress and the Bush administration have been trying to contain the rapidly growing costs of entitlement programs, such as Social Security, Medicare and Medicaid. Legislators have created a commission to study ways to cut Medicaid by $10 billion over a five-year period.

Dr. Sullivan, former secretary for the Department of Health and Human Services, said that curbing fraud could save huge amounts of money for Medicaid.

Stan Dorn, an analyst with the Economic and Social Research Institute, said Medicare already has a working solution.

“In Medicare, there has been a bounty-hunter statute where if you know someone who is committing fraud, you can charge them as a private citizen and target that person for the government. We can use that with Medicaid as well,” Mr. Dorn said.

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