Doctors who get caught with their hands in the Medicaid cookie jar go to prison. When the state of California blatantly commits a “massive” billion-dollar case of billing fraud, all that happens is that the Inspector General releases a report.
Hard working physicians, doing their best to help low-income patients, fight incessantly to justify every single procedure they bill for. Meanwhile, California officials enrolling “hundreds of thousands of ineligible adults in Medicaid” don’t face a single consequence.
This is “Californication” at its finest, as The American Spectator points out, “the taxpayers don’t even get a kiss.” California took full advantage of the confusion caused by the Obamacare expansion of Medicare.
Liberal democrats in The Golden State found a way to work the Obamacare goldmine by signing up illegal aliens left and right. Every one they added to the list was good for a future check from Uncle Sam.
The Office of Inspector General (OIG) branch of the Department of Health and Human Services (HHS) estimates that California’s blatant abuse defrauded more than $1 billion from the federal government and taxpaying citizens.
That figure is probably on the low side. The auditors only sampled records from October 1, 2014, to March 31, 2015, a six-month span.
When doctors do the same thing that California state officials did, they go to jail. In one typical case, A doctor in the Boston, Massachusetts suburb of Brookline got 11 months in prison. He also had to pay a $9.3 million fine for “running a Medicaid fraud scheme.”
Another doctor, this time in Saginaw, Michigan, was hit with three counts of billing fraud. He is looking at a possible four years on each count, along with $50,000 in fines for each as well. These are only two examples of the kinds of cases that are prosecuted every day.
Each and every time, the charges are “fraud.” California committed exactly the same crime and they did it on an enormous scale.
The OIG report confirms, “On the basis of our sample results, we estimated that the State agency made Medicaid payments of $628,838,417 (Federal share) on behalf of 366,078 ineligible beneficiaries and $402,358,529 (Federal share) on behalf of 79,055 potentially ineligible beneficiaries.”
That totals up to more than $1 billion spent illegally on more than 450,000 people, who were not supposed to get a single dime.
When the auditors talk about the “federal share” they make it seem like California also kicked some money into the pot. That didn’t happen.
The federal share that comes out of taxpayer pockets is 100 percent of the bill.
The audit report spells that out. “For the period of time covered by the OIG audit, the federal share of the costs for newly eligible, adult enrollees is 100 percent.”
Surprisingly, the legal low-income residents of the state, that the program was created for in the first place, would be generating some state matching funds.
Intended to cushion the blow to the states as they enrolled waves of newly eligible patients, the government agreed to foot the whole bill for those just signing up.
As stated in Section 2001 of the Affordable Care Act, aka Obamacare, the government allowed “an FMAP [Federal medical assistance percentage] of 100 percent for the qualified expenditures incurred by newly eligible beneficiaries enrolled in the new adult group.”
The plan called for the figure to remain at 100 percent until 2016, then drop off to 90 percent by 2020.
What California did illegally, and on a gigantic scale compared to dishonest doctors, was bill Medicaid for money that it was not entitled to in the first place.
The laws clearly say “the state must verify that the applicant meets citizenship and residency requirements.” That means illegals do not qualify for benefits. Period. Not even in a “sanctuary” state.
Applicants also have to have household incomes below a maximum threshold, meet age and other requirements. Critically, each applicant is required to provide a Social Security number.
In California, they made no attempts to verify any of the information. None at all. When the OIG started looking at the applications, they found that “18 percent of enrollees are obviously ineligible.”
When they say “obviously,” it means that somebody intentionally didn’t do their job. Even the not so obvious ones had application problems that should have been caught. “All of these enrollees failed one or more” of the requirements, the OIG wrote.
The inspectors explain that by not determining eligibility according to the rules, it was virtually guaranteed that the state would be paying the bills for “ineligible beneficiaries” which would then be passed along to the federal government.
The report clearly says that when they do that, they are claiming “unallowable Federal reimbursement.”
The loophole that corrupt California politicians are exploiting is the fact that there is no penalty to the state. The more illegals they get on the health care coverage books, the bigger the checks that come in from Washington, D.C.
You would think that any state caught doing something so obviously underhanded would have their federal matching funds chopped off instantly, but that makes too much sense for Washington.