Guest column: Medicaid Is Mismanaged Tax Dollars

Alieta Eck, MD, President, Association of American Physicians and Surgeons

The essence of Government is power; and power, lodged as it must be in human hands, will ever be liable to abuse. James Madison.

When government controls health care, bureaucrats war against bureaucrats, medical care becomes a commodity, and the taxpayers pay dearly.

The federal government audited  NJ Medicaid and determined that the state owes the federal government $145 million due to “mismanagement.” It claims that the state “improperly oversaw  Medicaid patient-care services,” the part of Medicaid services involved in the “cleaning, grooming, bathing and shopping for patients” over three years beginning in 2004.

Those of us who are uninitiated in the expanse of the Medicaid program might be wondering what “cleaning, grooming, bathing and shopping” for people has anything to do with medical care at all. After all, isn’t Medicaid about medical care for the   poor?

Even assuming that this might be the proper role of government, looking at this accusation more closely would be enough to cause any rational person to cringe. The federal government took 19 million claims totaling $1 billion and “randomly selected” 100. It determined that 36 of those 100 should be disallowed, not because the services were not rendered, but because the state workers had not jumped through enough paperwork hoops.

Here is what they did wrong.   The services were provided without prior authorization from the state. The staff did not have proper “in-service” training. Nurses did not assess or supervise the staff and physicians did not provide a written referral. No one is claiming that the services were not rendered at all, so where was the “fraud?”

But in keeping with the utter lack of common sense, the feds took these 36 “fraudulent” claims, extrapolated 36% of the $533 million federal monies allocated for those services, and is now demanding $145 million back.

The state is protesting that it truly did the best it could and presented documentation, but the feds are standing firm. This assessment is now being added to the $35 million of “improper billing” for mental health services and $50 million for “improper   speech therapy, physical therapy and counseling” performed between 1998 and 2001.

It is time for the taxpayers of New Jersey to rise up and protest the squandering of our federal and state   tax dollars. No amount of oversight can possibly contain this raiding of our  collective pocketbooks.

We must rethink Medicaid completely. The federal government cannot possibly oversee the bathing and shopping for every Medicaid recipient. Whether the claims were technically fraudulent may never be resolved. However, the fact that $533 million taxpayer   dollars paid for such things at all should be questioned. What did we do before this behemoth program was established? Families cared for family members, neighbors helped their neighbors, and churches organized the ladies to support those in need.

Anyone who practices medicine and submits claims to any level of government is taking a great risk because  there is no limit to the ways that laws, guidelines, paperwork and details can be submitted improperly. Unfortunately, the over 65 Medicare population has no   alternative but to enroll in the Big Government Medicare. Furthermore, if the  Affordable Care Act is allowed to be implemented, younger Americans will be allowed fewer choices as well.

The State of New Jersey is getting a taste of its own medicine, for state agencies have shown heavy hands in dealing with its citizens. The state needs to pull away from the federally  controlled Medicaid program and facilitate the caring for the poor in more   innovative, local ways. Maybe a simple plan of protecting volunteers who donate their time and expertise to care for the poor would liberate the people  to meet most of these needs without any taxpayer dollars at  all.

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