Wednesday, August 03, 2011

Hearing First-hand: A Medicaid Administrator Speaks

From the Voice of the People section of today's Chicago Tribune:
I am an Illinois Department of Human Services worker who administers Medicaid, and caseloads have risen to unmanageable levels. The caseload size in my office has increased to around 1,380 per worker. We have deadlines and directives, too, like everyone else. We have to process vast amounts of work within agency time frames. In this environment, we don't have the ability to do a better job preventing fraud.

Illinois has one of the smallest state workforces in the country, and there is no hiring. Workers who retire are not replaced. It's a Catch-22: More people are applying for public assistance and are being serviced by fewer workers, and fewer workers have even more stringent deadlines. This is a recipe for abuse and guarantees that fraud will continue.
I suspect this problem is not unique to Illinois.



Anonymous said...

A possible solution is to hire private agencies to audit and find the fraud. Their fee is a percentage of the recovered funds - no cost to the government. Given them a big percentage. The real benefit comes if there is a feedback loop that identifies the types and methods of fraud and allows automatic detection programs to be built into the application process.

Dennis said...

The fraud perpetrators at all levels will drain the pond for the cash now and never give it a thought what will happen in the future. Its live for today and not to worry. I have said it before and I will say it again... I am glad I have lived the bulk of my life.

I just had hernia surgery as an out patient at my local hospital... a small city on the west coast of Florida. I was in hospital a total of seven hours and the bill was $67k... How is this possible? Of course Medicare and my military insurance will not pay that amount but I truly believe the bill is pumped to get the maximum return and we wonder why all these programs are going broke and they are cutting costs. There is no way this country and system can survive and no ordinary citizen can pay $67k for outpatient surgery. The alternative is to die.
I am not positive but this bill may have been more than my Pulmonary Vein Ablation which was additionally one night in recovery.
There is something wrong with this picture....

Pluripotent said...

Fraud is an intrinsic fact of government. Politicians have been saying for decades that they will eliminate "waste, fraud and abuse." It never happens. For medicare/medicade, however, you have to separate out criminal fraud from everything else. The government calls any undotted "i" on one of their forms "fraud." It's easier to scapegoat a group of honest physicians who get lost in the Byzantine mire of endless paperwork than it is to go after criminal fraud, so that's what they do.

The reason fraud/waste/abuse will never be vanquished is that it's a feature, not a bug. There must be ways to deplete the wealth of the citizens, otherwise, they would start doing things for themselves...and where would that leave government.