Iowa Has Issues With Medicaid Fraud In Its Privatizaion

Iowa seems to have had an epiphany when it comes to how poorly its Medicaid program is operating since it has been privatized.

Iowa Medicaid September 2016

The best way to measure a state's privatized Medicaid system is to look at its child welfare system, or rather child poverty rates.

In its September 2016 report, below, one can see from this pie chart that more than 51% of its children are enrolled in Medicaid managed programs.

This does not account for the "fee-for-service" nor does it capture its Targeted Case Management programs.

In essence, the child welfare Medicaid managed  programs would be the target of oversight.

Let us take a quick and dirty jaunt down memory lane with Iowa and review a few milestones in its handling of privatized Medicaid programs in child welfare.

Iowa Central Registry Ruling

Iowa Is A Statistical Hellhole For False Claims

Iowa cracks down on Medicaid fraud

Iowa Fails To End False Claims To Medicaid Fraud

Iowa Medicaid Fraud In Child Welfare Scheme Profits $120,000

Iowa Busted In $2.6 Million Child Care Fraud

So, at the end of the day, in all the States, as long as the States Medicaid Fraud Control Unit are legally hogtied in its ability to establish any prosecutorial oversight in Medicaid fraud due to:

• Statutory constraints in child welfare programs privacy;
• Non-coordination with the administrators of Medicaid and child welfare programs;
• No referrals to the Unit in suspected violations in law and policy in child welfare;
• Conflicts of interests with attorneys general in advocating and advising these contractual arms;
• Privatization of child welfare (now coined as modernization of Medicaid),

Medicaid fraud in child welfare will continue, the same as these Iowan legislators will continue to scratch their heads as child poverty increases and these private providers continue funding their political campaigns to stay in office.

There is just too much money to be made off "The Poors".

Robust oversight of Medicaid is needed

The state’s second quarterly oversight meeting of Medicaid modernization showed the need: Iowa lawmakers must work to provide more robust oversight of the system.

Three out-of-state, private providers manage the public health care system, which delivers essential services to more than 600,000 state residents and absorbs more than $5 billion taxpayer dollars.

Effective and cost-efficient management must be a bipartisan priority. It’s both a moral and economic imperative. All Iowans benefit from a system that delivers quality service at the lowest cost.

But such a system cannot and will not manifest on its own.

Iowa’s public health care system, formerly run by state government, is now administered by companies that naturally view profits and stock values as a top priority. While understandable, unchecked private-sector priorities have the potential to run counter to taxpayer and state interests.

Iowa Medicaid Enterprise Managed Care Organization Report: SFY 2017, Q1 Performance Data November 30, 2016 by Beverly Tran on Scribd

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