Is Medicaid broken or just misrepresented?

The North Carolina Department of Health and Human Services should do its job and put an end to mistaken Medicaid overpayments to doctors and hospitals, provide more thorough tracking and reporting of the accuracy of its payments and prevent overpayments in the first place.

The N.C. State Auditor’s Office found the mistaken payments by the state’s Medicaid program. By extrapolating sample reviews, the auditors disclosed a likely program-wide cost of $835 million, according to an Associated Press report.

The auditor’s office reviews how agencies spend federal money. It has routinely reported on problems in Medicaid billing over the years. Officials usually have just provided what they uncovered in a sample of provider payments, however, because that’s only what the federal government required.

The state might be required to give no more than required samples to the feds, but North Carolina taxpayers require more than that, including fully engaged management and oversight.

The overpayments occurred in part because of insufficient paperwork to prove that services occurred, ineligible medical providers seeking to get paid and payment rate mistakes, the audit said.

If there is insufficient proof of services, payment should be denied to providers and internal audits should be in place to prevent mistakes. In short, the Medicaid system should be run properly and efficiently. If it does not, what did Gov. McCrory fix?

In its written response within the audit, DHHS, which oversees Medicaid, said only 31 of the 50 sampled payments were actual errors, based on the state Medicaid agency’s independent review. Using its statistical sampling method, the department calculated the error at $690 million, not the reported $835 million.

Later, the department said in a statement that projecting the sample for a Medicaid-wide overpayment didn’t offer “a correct picture for North Carolina citizens. It is not accurate, nor reasonable to believe that North Carolina overpaid providers by this margin.”

Nevertheless, the department found the auditors reliable enough to use for comparison with the previous year’s sample showing a 24 percent error rate versus an improved 13 percent error rate in Monday’s report.

Whatever the error rate is, $835 million in projected errors or $690 million worth of errors both reflect inadequate oversight and management.

Monday’s report cited other issues, including duplicate payments to food stamp recipients and inaccurate performance reports on federal funds used for North Carolina’s welfare program.

The General Assembly’s Joint Oversight Committee on Health and Human Services should address all these problems at today’s scheduled meeting and provide some answers. Pitt County legislative delegates Sen. Louis Pate (co-chair) and Rep. Susan Martin are members of the committee.

Gov. McCrory railed against such problems when he ran for office and said his administration would correct them under his leadership. Please do.

http://www.reflector.com/Editorials/2016/04/12/Medicaid-still-broken.html