New analysis estimates $1.1T in Medicaid improper payments

[Curried Goats]

About half the estimate is based on people states improperly may have placed on Medicaid under the ACA who were not eligible. The Paragon Health Institute study took the two years they looked at the numbers and applied the same error rate across the whole ten years they analyzed so who knows how accurate it really is. Those two years were all the info they had to work with though because Obama and Biden refused to let the auditors include eligibility reviews in the audits during their administrations. Medicaid’s True Improper Payments Double Those Reported by CMS

If you click that link and read that article and also the reports it links to you'll see that States, not blue States or red States but pretty much all States are using some tax scheme to take that federal reimbursement money to Medicaid and Medicare to give kickbacks to providers and hospitals rather than that money going to actually help the people it's intended to. The solution to that is to end their ability to do so, not to cut Medicare and Medicaid.

 

[Dekster]

If you click that link and read that article and also the reports it links to you'll see that States, not blue States or red States but pretty much all States are using some tax scheme to take that federal reimbursement money to Medicaid and Medicare to give kickbacks to providers and hospitals rather than that money going to actually help the people it's intended to. The solution to that is to end their ability to do so, not to cut Medicare and Medicaid.

So you are opposed to states kicking people off Medicaid expansion who shouldn't be on it to begin with?

 

[Slade3200]

Yet the left scream over any attempt to reign in this fraud and calls it Medciaid cuts.

Yes, cut the improper payments.

What a scam.

Medicaid improper payments are much higher than the federal government reports, according to a new analysis from the Paragon Health Institute.

The conservative think tank released the analysis earlier this week, estimating about $1.1 trillion in Medicaid improper payments over the last decade. The estimate is approximately double the $543 billion CMS reported from its own audits.

Researchers from the Paragon Health Institute reached the $1.1 trillion value by including eligibility checks in their analysis, which they say CMS has "largely ignored" despite being "the biggest source of errors."

Under the Obama and Biden administrations, CMS did not include reviews of state eligibility determinations in their Payment Error Rate Measurement (PERM) audits, which have measured improper payments in Medicaid and CHIP since 2008. Improper payments are reimbursements from the government that do not meet statutory, regulatory or administrative requirements of the programs.

CMS did not include state eligibility determinations at times since establishing PERM audits. The Obama administration first halted eligibility reviews from 20152018. More recently, the Biden administration stopped eligibility reviews from 2021-2024 because of the COVID-19 pandemic.

However, eligibility is a major problem for Medicaid, especially after the Affordable Care Act, the think tank explained. The ACA allowed states to expand Medicaid to more individuals, many of which qualified for higher reimbursements from the government compared to traditional Medicaid populations.

Higher rates for newly eligible populations created "an incentive for states to improperly classify traditional enrollees, as well as ineligible applicants, as expansion enrollees," the analysis stated.

Additionally, hospitals have been able to enroll people in Medicaid under presumptive eligibility rules. Under these rules, hospitals can enroll patients based on income and household size to receive temporary Medicaid coverage pending a review. A 2018 report, however, found that about 70% of people deemed eligible by hospitals were eventually found to be ineligible or did not have their information verified.

The Paragon Health Institute also found that the official improper payment rate from CMS was significantly higher during the years when PERM included eligibility assessments as part of their official improper payment rates.

Without eligibility checks, the report said CMS is missing a substantial portion of Medicaid improper payments.

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New analysis estimates $1.1T in Medicaid improper payments | TechTarget

Learn more about Medicaid improper payments, which may total $1.1 trillion -- double CMS estimates -- due to overlooked eligibility and procedural issues.

www.techtarget.com

How exactly do you propose making these cuts?