Tuesday, November 28, 2006

In an editorial a month ago, we warned that “Blinding Medicaid waste and abuse” had created a $22.3 million hole in D.C. coffers. Now comes word that the failure to file the proper reimbursement paperwork for Medicaid and Medicare services has already caused overruns in the current budget. With the fiscal year having only started on Oct. 1, this is a red flag neither Mayor Tony Williams nor his successor can ignore.

D.C. Chief Financial Officer Nat Gandhi has warned Mayor-elect Adrian Fenty that the city already has overspent by $87 million, The Washington Post reported yesterday. That figure could rise to $300 million next year if spending reins aren’t gripped immediately. Most of the potential shortfall is attributed to rising costs for health care, and The Post cited higher-than-expected health-care enrollments as creating part of pressure. But much of the fault lies with an inefficient bureaucracy.

As The Washington Times reported and editorialized last month, an audit by the D.C. Inspector General found the city’s Medicaid program is in “serious breach of basic internal controls,” with D.C. officials spending $22.3 million on nonemergency transportation for Medicaid recipients. Problem is, they cannot determine whether the money should have been paid or not because transportation firms filed dozens of claims for Medicaid patients who were actually dead.



A health-insurance program for the poor, Medicaid transportation costs have been pushing skyward for some years now. The costs are of such concern to the 109th Congress, that as part of the Deficit Reduction Act, it also created the Medicaid Integrity Program, granting open-ended authority to the federal Department of Health and Human Services to tackle Medicaid waste, fraud and abuse — authority that was relegated previously to the states. The District, amid its spending frenzy on nonemergency transportation, didn’t catch on. As we said in our Oct. 27 editorial, “We could point fingers at City Hall… This time, though, we are just grateful that the feds are looking in the right direction.”

Indeed, while federal and local auditors scrutinize the District’s Medicaid spending habits, Congress has put City Hall on notice, too. Sens. Charles Grassley and Max Baucus, the chairman and ranking member of the Senate Finance Committee, said in a Nov. 17 letter to the D.C. inspector general that they want details on “all ongoing audits, evaluations and investigations that examine the Medicaid program in the District of Columbia.” And well they should: National nonemergency Medicaid transportation costs have reached $1.5 billion — a 48 percent increase since the 1999-2003 period.

This isn’t the first time the District has been warned about its egregious Medicaid offenses. As the senators say in their letter, previous probes have cited “unnecessary trips and excessive claims as well as billing Medicaid for trips never provided.”

The D.C. lawmaker chiefly responsible for Medicaid oversight, David Catania, told reporter Jim McElhatton that he was “delighted” with the steps City Hall has taken to reform the Medicaid. We do not share Mr. Catania’s enthusiasm. Neither the District nor the several states that are wasting tax dollars should be let off the hook. We thank the senators for their ongoing inquiry, and hope they continue with the knowledge that bureaucracies like the District’s don’t quickly reform themselves.

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