Friday, April 7, 2017

Colorado Hustles Medicaid Billing For Campaign Contributions

You know what was not 'caught'?

Fraudulent billing through the state privatized contractual services through Medicaid.

Something tingles my spidey senses that Colorado could owe even more if its Medicaid Fraud Control Unit  could actually possess some form of statutory authority to go after Medicaid fraud in child welfare.

Alas, we shall just have to wait for our fraudfeasant elected officials to tire from bilking campaign contributions from their authorization of these fraud schemes.

These are not "system errors".

These are strategically planned fraud schemes to maximize revenues off the backs of "The Poor" (said with clinched teeth).

They bill, they bill, they bill, with or without a child in custody.

Colorado could owe feds up to $43 million for Medicaid “systems error”

An employee fills prescriptions at a community health center on March 27, 2012 in Aurora.State officials disagree on whether feds will make Colorado repay the debt.

A “system error” at the state Medicaid department could leave Colorado taxpayers on the hook to repay the federal government as much as $43 million, an unexpected expense that state officials are scrambling to reconcile.

The department’s computer system “erroneously categorized” some services as eligible for more federal funds than they were, according to a memo sent Wednesday to lawmakers on the Joint Budget Committee from a committee staffer.

The state Department of Health Care Policy and Financing, which oversees Medicaid government health insurance for the needy and disabled, estimated the federal payback would total anywhere from $21.8 million to $43.4 million. The department is fixing the system error for Medicaid claims beginning this month, but the problem dates back to July 2015.

“This should have been caught,” said state Sen. Kent Lambert, R-Colorado Springs, who chairs the JBC. “The fact is, it wasn’t.”

There’s deep disagreement within Gov. John Hickenlooper’s administration about what the state will ultimately owe, according to the memo.
Some state officials were described as optimistic that the federal government will forgive some or all of the debt, saying the Obama administration had historically been lenient when states made mistakes in implementing the Affordable Care Act. Others were said to be incredulous at the idea that the Trump administration would require anything less than full repayment.

The computer system wrongly calculated that thousands of people were eligible for an “enhanced” federal match that applies to those who were added to Medicaid rolls because of the Affordable Care Act.

The department blamed the Colorado Benefits Management System, the computer system that has plagued Colorado for years with security breaches and errors. A “programming update” slated for later this month will correct the system error, said Health Care Policy and Financing spokesman Marc Williams.

The state has been receiving reimbursements of 100 percent from the federal government for some Medicaid clients despite that federal funds should have covered just 50 percent of their benefits, Williams said. The federal Centers for Medicare and Medicaid Services has given states guidance suggesting the federal government will allow “for forgiveness of eligibility errors,” though it’s unclear whether Colorado will get forgiveness, he said.

The department made the budget request “in the event” the federal government wants a reimbursement, Williams said.

The governor’s office had asked the Joint Budget Committee to create a new cash fund of $25 million for “possible repayment to the federal government,” which would require legislation. JBC staff argued that a cash fund isn’t necessary and instead suggested an additional $25 million appropriation to the state budget to cover repayment.

Initially, the committee voted 4-2 to appropriate $25 million, as the JBC staff had suggested. But later in the meeting, the budget writers changed course and opted to do nothing — for now — and wait until the state is actually sent a bill.

“This is why we have a statutory reserve,” Lambert said.

This isn’t the first time Colorado has been overpaid for Medicaid-related services. An audit conducted by the U.S. Department of Health and Human Services’ inspector general’s office last year found Colorado erroneously received $38 million in federal bonuses for enrolling children in Medicaid who did not qualify.

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