Thread: State Medicaid may have to pay back $75 million

http://seattlepi.nwsource.com/local/268 ... aid28.html



Friday, April 28, 2006

State Medicaid may have to pay back $75 million
Audit finds unauthorized use of money for immigrants

By CHRIS McGANN
P-I CAPITOL CORRESPONDENT

OLYMPIA -- A state audit has questioned nearly $1 billion that Washington's Medicaid program spent last year -- including $75 million that may have to be repaid to the federal government because it was used for unauthorized medical services for undocumented aliens.

Undocumented aliens received prenatal care, chemotherapy, kidney transplants and other procedures the federal government prohibits its money from being spent on, the audit released Thursday found.

The report examined Medicaid payments in the fiscal year that ended in 2005.

Medicaid, a joint state and federal program, spent $6.2 billion last year on health services for the state's poor and disabled.

"We found no improvements in the ... controls from previous years," the audit said. "Washington state is providing service to thousands of ineligible clients using federal Medicaid money. The majority of these clients were admitted into the program due to unaddressed significant weaknesses in the department's controls. This is causing the nation's taxpayers to subsidize Washington state's non-compliance."

The U.S. Health and Human Services Department began reviewing Washington's Medicaid spending on undocumented aliens in March, but it has yet to determine how much, if any, federal money should be repaid.

State Medicaid Director Doug Porter said the federal report most likely will recommend policy changes and tighter controls on how the federal money is spent.

"We might owe them money back -- we might not," Porter said. "Largely, the federal government will determine: Did we make a mistake that was an honest mistake that can be corrected? Or were we trying to game the system and rip off more federal money than we were entitled to and we knew it? That largely drives the corrective action."

Porter said he hopes investigators' findings will concur with what he believes are the facts: "We were looking at the regulations and making the best sense out of them as we could."


In that case, Porter said he expects the federal government to clarify its rules instead of issuing sanctions and a demand to repay the money.

Porter said he's skeptical that the government will demand the full $75 million to be repaid.

"We think what's really at risk is something on the order of maybe $8 million or $10 million," Porter said.

State Auditor Brian Sonntag said it's not up to his office to decide how much of the total liability would have to be repaid.

"What we're going to do is identify improper payments. We're going to identify problems in the audit report," Sonntag said. "In the follow-up, the federal government will determine what or how much has to be repaid. ... Ideally, you wouldn't want to be misspending any of these dollars."

Sonntag said he's concerned that most of the 28 findings in this year's audit were flagged before.

"A lot of these issues are repeat issues," Sonntag said. "You've read these in previous audit reports, and here they are again."

But on the upside, Sonntag said the response from the new head of the Department of Social and Health Services was encouraging.

DSHS Secretary Robin Arnold-Williams said she takes the latest audit findings seriously.

"We share a common goal of ensuring the proper use of public funds," she said.

Sonntag said Arnold-Williams' attitude and commitment to resolving audit issues was "very refreshing."

Animosity and a lack of cooperation between agency officials and the auditors marked Sonntag's previous Medicaid audit.

The 2005 audit found that DSHS and Medicaid:


Lack a reliable system to identify treatments and services that are not covered by the Medicaid plan.


Spent federal money on services for undocumented aliens. They did not adequately review pharmaceutical claims for fraud and abuse.


Lack adequate internal controls to prevent Medicaid payments to dead people or people using a dead person's Social Security number.

Porter said the findings could be broken down into three main categories: One, the federal government is giving mixed signals in interpreting its own rules; two, DSHS and auditors are interpreting the rules differently; and three, DSHS and the federal government have agreed on an interpretation of the rules and the Auditor's Office is just wrong.

"We just plain disagree on some issues -- and will likely continue to disagree," he said.

Porter and Sonntag agree that the federal investigation will prove useful in at least clearing up conflicting interpretations.

"What we're looking for is the federal government to come in and provide some clarification to DSHS and to our office," Sonntag said. "This was supposed to happen a couple years ago, and we are very encouraged that it will happen now."

Porter said the department is trying to move quickly to address the problems they do agree on.

"If we haven't already started a correction, we will," he said. "We would like to have that done and in place before his next audit commences"

More momentum!! I heard about that law last night. There is also a law that states you can not give benefits to a non-citizen that you are denying to citizens. That is a big issue with TennCare because the Citizens had it taken away and the illegals are keeping it.