HB 1090: CREATING FRAUD AND PROFITS WHILE SCAPEGOATING MEDICAID
WHAT COULD GO WRONG?
Our Mississippi Legislators are at it again, using our state Medicaid program as a piggy bank and creating a state boondoggle within our financially strapped Medicaid program. For the second year in a row, House Medicaid Chairman Chris Brown introduced the HOPE Act. HB 1090, better known as the Act to Restore Hope Opportunity and Prosperity to Everyone (HOPE) is a bill that claims to reduce fraud in the Medicaid program.
Just Follow the Fraud!
While Medicaid currently faces being underfunded $88 Million, Chairman Brown has somehow found enough funding to provide an out of state company millions of dollars to do what our Medicaid employees are already doing. As HB 1090 winds through the legislative process, the bill's true intentions become exposed.
HB 1090 proposes to hire a third-party vendor to do additional income verification for the Division of Medicaid and Department of Human Services programs to "ensure that only those who need the program are on the program." Upon closer inspection, the supposed savings that will result by hiring this third-party company are based on unrealistic estimates. Last week when the bill came up for debate in the Senate Medicaid committee Republican Senator Terry Burton questioned both the costs and savings of the bill.
"These are not hard numbers because nobody can get hard numbers on this," Burton said. "I don't want anyone here to think these are hard numbers or we're going to save about $29 million in Medicaid. Because some third-party vendor is going to get a real sweetheart deal on this (vetting program). So I think the assumptions, and the estimates, all these things that are included in this fiscal note are tremendously, tremendously overestimated."
Besides the questionable fiscal sense of HB 1090, there has been little effort placed on rooting out provider fraud, where there is historic and well documented evidence of fraud. During the House Medicaid committee debate of HB 1090, there was strong opposition by supporters of the bill to an amendment that would detect provider fraud; Representative Omeria Scott eventually succeeded in adding a provider amendment to the bill.
There is no Greater Fraud than a Promise not Kept.
This bill is increasingly looking like a solution, in search of a problem. Ultimately, HB 1090 will hurt the recipients that need these services, over half being children. The HOPE bill is clearly designed to reward out of state corporations at the expense of Mississippi's families and children. The bill authorizes a yet to be named contractor to verify beneficiaries' financial information in a credit card like process. Medicaid will allow vendors access to a beneficiaries' income, residence, and other identifying information through electronic sources. These functions are already carried out by the hundreds of Medicaid specialists we have all over the state now. Medicaid beneficiaries, who are found to have a discrepancy with the information of the vendors, will only have a short ten days to respond before they are removed from the program. This short notice will ensure that people that are eligible and still need the program will be thrown off.
In states like Illinois, we've already seen how this boondoggle targets children and families. In January 2013, Illinois awarded Maximus an $85 million contract to do additional Medicaid eligibility screening. While Maximus identified over 300,000 that would be considered ineligible for their Medicaid benefits, their eligibility error rate was a stunning 58% percent! These so called "fraudulent" beneficiaries ultimately bear the brunt of these unscrupulous vendor contracts. After the public outcry about this ineffective program, the state cancelled the contract and put more resources into state workers that were already doing the work. The HOPE bill has little to do with program integrity and more to do with scapegoating Medicaid recipients.
Contact your State Representative and Senator TODAY at (601) 359-3770. Tell them that our state Medicaid program and the services it provides to our children, elderly and disabled are too important to sell out to the highest bidder.
- Uses funds that could be spent to shore up the Medicaid program to give an unnecessary, expensive contract to an outside vendor for work that our state Medicaid employees already do.
- Puts coverage at risk for over 700,000 Mississippians by giving an unaccountable, out-of-state entity power to determine who is eligible for the program.
- Does little to address the source of meaningful fraud and waste, providers.