The U.S. Department of Health and Human Services Office of Inspector General has published its findings of meeting the requirements of reporting and recovering improper payments. Without surprise it was reported that there were reported improper payment information for its child welfare programs, including no corrective action for recovery of the improperly reimbursed programs.
The report specifically addressed Medicaid fraud in child welfare, including its ancillary programs of Title IV-E and B, a.k.a. foster care, Temporary Assistant to Needy Families (TANF), Child Care Development Fund (CCDF) and Child Health Insurance Program (CHIP).
As stated in the report one of the reasons there was no rate reduction in improper payments was due to poor, if not lack of reporting by the States.
This can be easily translated into one simple term: Secrecy.
Secrecy in the validation of child welfare payments go far beyond "protecting the best interests of the child". Secrecy expands the broad universe of protecting the status quo of program operations and goals. The operations are archaic and the goals have never been met. It can be viewed as an iron curtain.
Simply put, child welfare does not perform the way it is promoted to function.
One performance standard which does not even exist is the function of the States Medicaid Fraud Control Units. How is it, when, a State Medicaid Fraud Control Unit (MFCU), warehoused in the Attorney General Office has the option of recovering improper payments of its child welfare programs, specifically foster care, can contemporaneously advocate and advise the same Child Placing Agencies it defends?
Continuing along the line of MFCU omissions of oversight, there are no referral mechanisms of a State's Medicaid program for improper, or even questionable activities for that matter.
The entire situation becomes apparent as a conflict of interest, allowing States to opt for the financial penalties of program funding for the simple fact that child welfare programs are outside the scope of an appropriated budget, or rather they are outlier payments reimbursed after the fact.
States will make up for the federal financial penalties with its child abuse propaganda campaigns to raise money, with the money from improper claims, to continue to keep its operations unscathed from reform. Continuing a culture of contractual entitlements is just another fancy way of saying false claims.
A few years ago I attended one of the symposiums of the DOJ and HHS partnership on health care fraud enforcement. When I spoke on the ills of oversight regarding questionable cost reimbursements, one of the agents on the stage dismissed me. There was DOJ video of this but it does not seem to be currently available. That agent can now eat his words in the reading of this report.
With the pending first implementation phase of the Affordable Care Act, States are facing severe challenges of meeting reporting, recovery exclusion requirements of its child welfare programming.
Until there is some form of transparency, a broadly ambiguous term in itself, the contractual culture of entitlements will never change.
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