Tuesday, December 19, 2017

Now They Care About Healthcare Fraud

Senator Bryan Kind called the "Private Option/Arkansas Works" a "scam" and there is a lot of evidence to suggest he is correct. That is why I asked the question "is the ruling class of Arkansas perpetrating welfare fraud on a massive scale?" But of course the first three years the Feds were picking up 100% of the tab, and it seemed that no one in state government cared if the people they were signing up were eligible or not. After all, the more people on the roles, the more payments from Fedgov went to Arkansas insurance companies.

Then the state started having to match. They were only required to pick up 5% of the cost at first, but even that was a strain. Soon they will be required to pick up 10% of the cost and so now they care. They wound up cutting 10% of the people off of the program in the first round of fraud checks they did. Those were done grudgingly after King and others pointed out that federal law required eligibility check.

Now they are not doing it grudgingly. Now comes the part where we are supposed to pony up 10% of the cost from the state budget and we haven't got it! So they want to shed people. The Governor has a plan to take those at the higher income part of the "Arkansas Works" spectrum (100% to 138% Federal Poverty Level) and move them to the Exchange. That will take about 60,000 people out of "Arkansas Works" just in time for Arkansas State Government to avoid picking up the tab. They will be shifted to a federal program that taxes others on the exchange (so expect to see the premiums of middle class and above go way up) and also pays from federal coffers (with borrowed money of course). The state has no fiscal liability though, and that is driving all decisions on this thing so far as I can tell.

Recently they did another eligibility check on 140,000 folks that had not been checked in the first go round. A shocking 80,000 of 140,000 were not entitled to be on the program! That is over a 50% rate of misuse. Here is a breakdown of some of that 80,000 from this link.

Working with the Department of Workforce Services to capture unreported employment. That resulted in 16,467 cases being closed.

Identifying individuals receiving public benefits from more than one state, which resulted in 25,742 cases being closed.

Establishing a process to sort large volumes of returned mail due to bad addresses. That resulted in 26,093 cases being closed because beneficiaries are required to report change of address so that DHS can ensure they remain in state.

Identifying those on Medicaid now eligible for Medicare, which resulted in 7,198 cases being closed because Arkansas Works enrollees cannot have both Medicare and Medicaid.

Removal of individuals incarcerated by the Department of Corrections from the rolls because inmates are generally not eligible for Medicaid. That resulted in 4,131 cases being closed.

Remember that the federal government was making payments to Arkansas insurance providers for each of these ineligible persons for an unknown amount of time. I think the jig is up and the powers-that-be are trying to clean up their books and cover their tracks as fast as they can. Could this have something to do with why the Governor recently decided to switch information system vendors over the company who has been doing it without any obvious problems for many years even though the company they are switching to bid $20 million dollars higher? Could it be that the information needed for the feds to recoup the money they paid out for bogus enrollments will be "lost" in the vendor transition?


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