More Bogus Budgeting?

June 15, 2015

I have attached for you below an article from Sunday’s Waterbury Republican-American which reveals how Gov. Malloy’s anti-fraud initiative is NOT meeting its savings goal. Was it bogus budgeting to begin with? Call the governor Monday at 800 406-1527, urge him to “Veto The Budget Bill”, and keep visiting . Thank you!

Medicaid savings short
Waterbury Republican-American
June 14, 2015

HARTFORD — The Malloy administration is having a hard time accounting for how much a vaunted anti-fraud initiative has saved the Medicaid program after acknowledging it will not hit its $104 million savings target.

The governor’s budget office now says a precise figure is hard to quantify after previously calculating stepped-up efforts to root out Medicaid fraud and reduce other improper payments would save that much this year.

The Office of Policy and Management provided a ballpark figure of $78.6 million, but this estimate also included projected future savings from costs that the state would have paid if errors, fraud and waste had continued to go undetected.

The state government cannot spend money it expects to save down the road to pay its bills this year. The $104 million in assumed Medicaid savings was built into this year’s $19 billion budget.

The failure to fully achieve the expected savings and other problems in the Medicaid program contributed to a nagging budget shortfall, including a costly billing dispute with the Centers for Medicaid and Medicare Services.

The Office of Policy and Management first reported a budget gap had opened up just after Gov. Dannel P. Malloy’s re-election in November, and it persisted and widened over the ensuing months despite the administration’s efforts to manage it.

In monthly budget reports, OPM Secretary Benjamin Barnes was reporting difficulties in achieving the full savings from the fraud initiative, but no figures were provided other than the overall deficiency in the Department of Social Services for the month. The agency administers the Medicaid program.

The savings from the anti-fraud initiative are hard to quantify because of the lengths and time involved confirming payments were improper and recovering improper payments, said Gian Carl Casa, a top deputy in OPM.

As a result, the amount of the state’s actual recoveries are constantly in flux, he said.

The Office of the Attorney General reported last Monday that the state will be recovering $300,000 from three dentists who were accused of participating in an illegal scheme to defraud Medicaid of $24 million three years ago.

THE SETTLEMENTS ANNOUNCED LAST WEEK demonstrate Casa’s point about how much time and effort goes into recovering improper Medicaid payments once they are identified. If there is no out-of-court settlement or plea agreement involving restitution, recoveries only occur after a civil or criminal case has been resolved in the state’s favor, Casa said.

Typically, repayments to the state do not occur in the same fiscal year that the investigation was initiated, he said.

ATTORNEY GENERAL GEORGE C. JEPSEN FILED SUIT over the dental fraud scheme as the 2012 fiscal year was drawing to close. The latest round of settlements was announced as the 2015 fiscal year nears its end on June 30.

There are also holds placed on payments while questionable billing practices are reviewed, Casa said. Held payments may be paid out during the course of a fiscal year if bill practices are validated.

In one of the settlements announced last week, a Cheshire dentist also agreed to forfeit $179,289 in suspicious payments that the Department of Social Services had suspended.

THE $104 MILLION IN MEDICAID SAVINGS was still included in this year’s $19 billion budget despite the fluid nature of that number.

Two leading Republican lawmakers question if it was just a gimmick that Democratic administration and the legislature’s Democratic majority used to balance this year’s $19 billion budget on paper and dodge the state spending cap.

The assumed Medicaid savings meant Malloy and Democrats did not have to find that $104 million from somewhere else. The assumption also helped the 2015 budget squeeze under the state spending cap by $25.9 million.

Sen. Robert J. Kane, R-Watertown, said he is not surprised the administration is now saying the actual savings are harder to quantify than the assumed savings were when the 2015 budget was being prepared. He is the ranking Senate member of the Appropriations Committee.

Sen. Joseph C. Markley, R-16th District, said the inclusion of the $104 million in Medicaid savings struck him as another example of bogus budgeting. He is the ranking Senate member of the Human Services Committee.

OPM’s Casa defended the budget assumption as reasonable, citing the significant expansion of Medicaid under the Affordable Care Act and the administration’s beefed up efforts to prevent fraud, waste and abuse.

While the anti-fraud initiative came up short of this year’s savings target, Casa said the administration remains the confident ongoing program is going to produce big payoffs between future recoveries and savings.

This year’s Medicaid program has a $5.6 billion budget between the state and federal shares. Even a small percentage of improper payments can have a significant effect on costs.