Let’s put aside the unsexy topic of Medicaid for a second and just zoom in on one number: $40 million per year. That’s $40 million we can divvy up among our public school systems. It’s $40 million we can spend on services for the elderly, infrastructure or on economic development. And it’s that number that has become the average savings each state can gain through legislation like the bill I have introduced this year, which would allow Rhode Island to use technology to identify fraudulent activity in the Medicaid and Children’s Health Insurance Program (CHIP) before payments are made.
The federal government has taken unprecedented steps toward health care reform in this country, but why should we not take our own steps to implement protection from fraud as our system evolves? I have expressed my support and gratitude for Gov. Lincoln D. Chafee’s preliminary moves in making this legislation a real possibility. However, without a law, the state will be moving along this road at a tortoise’s pace.
The state has been rolling up the packet of toothpaste every year and oozing out less and less state aid to services and districts that really need assistance. This legislation, however, would have a full and immediate effect. One-time fixes are frowned upon in both the financial and physical world – we need a system in place. As Reason Magazine Senior Editor Peter Suderman noted in his 2011 article regarding Medicare fraud on the federal level, “schemers, career criminals and unscrupulous providers take advantage of the government’s lax controls over Medicare payments. Taxpayers are lining the pockets of health care criminals.”
The federal government has estimated that state Medicaid programs pay around $18 billion total annually attributed to fraud, waste and abuse of the system. Between 2007 and 2011, Suderman pointed out that the federal government won convictions against 990 individuals in fraud cases totaling $2.3 billion. One of those convicted criminals said committing Medicare fraud is no more difficult than summer temp work at a call center. If it was this easy to swindle Medicare, how easy would it be to do the same with Medicaid?
Suderman continues: “Every politician with a pulse talks a big game about eliminating Medicare ‘waste, fraud and abuse,’ yet nothing much seems to get done. The bigger the government’s role in paying for Americans’ health care, the easier it is to divert that revenue stream into the bank accounts of criminals.” Keeping in mind that we just had a complex health care overhaul, I fear that we are actually inviting more fraud to take place while we transition.
My bill (2013-H 5734) has the full support of state Secretary of Health and Human Services Steven Costantino, who personally wishes to take more preventative action against fraud and waste. Pre-payment prevention and recovery solutions are the necessary steps we must take to bring that number as close to zero as possible. The technology is available; it is time to begin using it to our advantage.
Rep. Patricia A. Serpa
District 27
Chairwoman, House Small Business Committee