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Medicaid fraud must be moved to PA forefront

The laudable anti-Medicaid-fraud initiative announced Monday by Pennsylvania lawmakers would, if enacted, establish a strong framework for ensuring that the money in question is used to benefit people who truly need it and punish those who receive such funds illegally.

However, an appropriate question is why Pennsylvania, which is one of America’s top eight states in terms of Medicaid spending, is the only one still without a False Claims Act already in place.

Some state residents also might be wondering why lawmakers only now are getting around to introducing a package of bills to attack Medicaid fraud when the Legislature, since last March, has had a grand jury’s findings on ways to prevent such fraud — although perhaps lawmakers were awaiting a report released recently by the House Government Oversight Committee.

But there are other possible reasons why lawmakers only now have reached the point of introducing anti-fraud legislation: the complexity and broad scope of the issue and the fact that the Pennsylvania General Assembly is not the most efficient legislative body in terms of acting on issues, even important ones.

Regarding efficiency, it will be interesting to watch whether a proposed state ban on drivers using hand-held cellphones, the topic of a Mirror article Thursday, will pick up speed in the Senate after having been passed on Wednesday by the House of Representatives — or whether the good-sense ban will languish without action until the end of the current legislative session.

If the Senate doesn’t take action, the measure will have to be reintroduced when the new two-year legislative calendar begins next January for any chance of achieving passage. Anti-Medicaid-fraud bills would be subject to the same fate if those measures aren’t law by the end of this year.

On Pennsylvania’s Medicaid anti-fraud legislation, however, which would strengthen requirements for Medicaid providers, there would seem to be fewer grounds for concern and opposition than the points that have been raised regarding hand-held cellphones.

The Medicaid-related bills to be considered center on adopting a state version of the Federal False Claims Act, require agencies to assess their susceptibility to improper payments, and establish a searchable database, modeled after the federal Do Not Pay law, that would help identify organizations, individuals and entities not eligible to receive funds from a state agency.

Beefed-up penalties for knowing or causing a fraudulent claim to be submitted, which are covered by another proposed measure, would be an incentive for anyone to think twice before obtaining Medicaid money improperly.

Meanwhile, anyone who might doubt whether Medicaid fraud really is a problem in Pennsylvania needs to consider a report from the U.S. Department of Health and Human Services’ inspector general, stating that the Keystone State has experienced $694 million in improper Medicaid payments.

Republican Leader Bryan Cutler of Lancaster County stressed that Pennsylvania is “overdue for relevant and important (Medicaid-related) reforms” that not only keep closer watch for those intent on taking advantage of the system but also find ways to make the program more useful and reliable for state residents in need.

Lawmakers need to work overtime, if necessary, to eradicate this example of despicable fraud that negatively impacts everyone in this state who pays taxes, as well as hurts those truly in need of the program’s benefits.

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