PLUNKETT: Perplexed Democrats Challenge Unprepared Republicans In State Senate To Provide Evidence Of Medicaid Fraud. Thank Goodness Someone Had Heard Of Google!

By Keith Plunkett | March 8th, 2017 at 5:08 am

BY: Keith Plunkett / Editor

Keith Plunkett is a Policy Consultant, Editor, Writer, Founder and Publisher of

Filed Under: Brice Wiggins, Budget, Contributor, Culture, David Parker, Democrats, Entitlements, Ethics, Federal Government, health, Hob Bryan, Insurance, Keith Plunkett, Legislature, Medicaid, Medical Care, Mississippi, Mississippi PEP, Mississippi State Senate, MS Attorney General, MS State Government, Opinion, Politics, Republican, Spending

An exchange between Democrat and Republican Senators on Tuesday reported by Mississippi Today illustrates why changing the schedule of legislative sessions to every other year instead of annually is a good idea.

A bill to tighten oversight of Medicaid and reduce improper payments brought heated debate in the state senate for an hour. If the quotes of some State Senators in the report are a proper representation of the dialogue that occurred for the entire hour then there has never been a more perfectly documented example as to why we need term limits in Mississippi.

Either that or there may be a gas leak at the State Capitol, because it sounds as if brains were foggy.

House Bill 1090, handled in the senate by Senator Brice Wiggins, gives Medicaid the authority to contract with a third party vendor to vet the eligibility of new beneficiaries and detect provider fraud such as over billing.

Apparently the very existence of improper payments from government agencies is a concept foreign to Democrats, so foreign that it completely confounded Senator David Jordan of Greenwood and left him unable to communicate a coherent point in response.

But, lucky for us, he tried anyway.


Fraud? What Fraud?

First though, Sen. Hob Bryan fatuously questioned whether Medicaid fraud was a serious enough problem in the state that it even needed addressing.

Now, considering Sen. Bryan has been such a vocal proponent of expanding Medicaid in Mississippi under the auspices of the Affordable Care Act, aka ObamaCare, you would think he would know that under the expansion provisions of ObamaCare a state would be required to:

  • Suspend Medicaid payments to individuals or entities where there is a credible allegation of fraud.
  • Impose temporary moratoria to prevent fraud, waste and abuse among new providers.
  • Establish Recovery Audit Contractor (RAC) programs to identify and recover overpayments and underpayments.
  • Enhance data system and expand Medicaid Management Information Systems data elements to identify fraud and abuse.

You would also think that he would know that there are 35 full-time investigators that are with the Medicaid Fraud Control Unit (MFCU) housed in Attorney General Jim Hood’s office, whose actions are 25-percent funded by the State of Mississippi (the other 75-percent comes from the feds). Surely Bryan reads the budget before he votes on it, right?

You would also think that Senator Bryan would know that the stats from all the MFCU’s are released annually by the HHS Office of Inspector General. Here are a few of the latest numbers available for Mississippi from 2015:

Total Medicaid Benefits Payments:                                  $5,313,720,236
Total Population Covered                                                                   740,937
Suspected Percentage of Fraud, Waste and Abuse                              10%
Suspected Amount of Fraud, Waste and Abuse               $531,372,024
Fraud Expenditure Recovery                                                    $14,838,348
Loss Per Day                                                                                         $1,415,161

I think it’s safe to say there is quite a problem with Medicaid fraud and abuse in Mississippi. I also think it’s safe to assume that Senator Bryan already knew that.

One can certainly understand why Senator Bryan and others in the legislature so intent on acquiring and expanding federal funding and federal control wouldn’t want to comment on the ineptitude of the federal government.

How inept?

The U.S. Government Accountability Office compiles data on improper payments by the federal government in all federal programs. They report that:

“since fiscal year 2003—when certain agencies were required by statute to begin reporting improper payments—cumulative improper payment estimates have totaled over $1 trillion. The improper payment estimate in fiscal year 2015, attributable to 121 programs across 22 agencies, was $136.7 billion, up from $124.6 billion in fiscal year 2014 (See Figure 1). The $12 billion increase was primarily due to estimated improper payments for the Medicaid program. The Medicare, Medicaid, and Earned Income Tax Credit programs account for over 76 percent of the government-wide improper payment estimate.”

Figure 1: Government-wide Improper Payment Estimates by Program for Fiscal Year 2015

Figure 1: Government-wide Improper Payment Estimates by Program for Fiscal Year 2015

With federal spending for Medicare and Medicaid expected to significantly increase, the GAO advises that “it is critical to take actions to reduce improper payments in these programs.”

Astonishingly, even with added focus on improper payments, Medicaid made an estimated $36 billion in payment errors in 2016, up from the $29.1 billion in 2015.

In its 2009 report on top management and performance challenges facing HHS, the HHS Office of Inspector General reported “multiple priorities related to Medicaid, including the need to ensure the integrity of payments to providers by ensuring they are appropriately enrolled and eligible to receive payments.”


Is Driving The Point The Same As Losing The Vote?

According to the reporter, it was Senator. David Jordan of Greenwood who “drove the point home” for the Democrats. The Senate, however, voted in favor of passage 30-17. So, the drive wasn’t all the way home. In fact, Jordan’s statement was so convoluted and disconnected it sounded as if he could use some directions.

Jordan argued the enhanced verification would unintentionally strip services from thousands of vulnerable residents. But how that would occur apparently to his thinking had something to do with a ‘scattering group of fraudsters.’

“My parents were share croppers and had no skills, and they died earlier because there were no programs to assist them in their senior years,” Jordan said. “And a lot of people die early because they’re getting cut off. … You have some (fraudsters) doing some things here, but they’re going to be scattered among the people who need the services.”

So, we’re to believe that out of an estimated $5 billion of fraud, waste and abuse in Mississippi the only thing we can hope to get returned is $14 million? And that’s because . . . fraudsters are scattered among the people who need Medicaid?

What in the heck does that mean? And what exactly does any of that have to do with whether or not they are eligible for the Medicaid program?


Passing It To See What’s In It

Senate Medicaid Chair Brice Wiggins, who presented the bill, attempted to answer Jordan.

“Nobody who’s actually eligible for benefits will lose benefits,” said Wiggins. “This is only for people who are taking advantage of the system. We don’t know they’re taking advantage of the system until we pass something like this.”

Yes we do know. We know the current recovery percentage. We know the amount. And we know the estimated amount of fraud still in the system. It’s more serious than taking advantage. It’s fraud. And if it were investigated, uncovered and dealt with then the state could use that recovered stolen money and possibly cover other “people who need the services.” And maybe they won’t “die early because they’re getting cut off” as Senator Jordan suggests is taking place.

Finally, Republican Senator David Parker rose to provide Wiggins with some leading questions “he said he had just looked up.”

“Would it surprise you that when Arkansas instituted a similar program, they found 494 dead enrollees and 43,000 enrollees living out of the state?” he asked Wiggins. “Would it surprise you that they found 4,000 people with a property net worth over $100,000?”

Thank goodness for Google!

Here’s another question for Republican voters to consider:

Would it surprise you that the state senate stumbled it’s way through legislation that could help reduce billions of dollars in fraud committed against the federal government? Would it surprise you that increasing the Medicaid programs integrity could potentially give back to the state of Mississippi millions in recovered matching Medicaid funds at a time when the outlook for recovery of our state’s economy is bleak?

Mississippians need leadership in a state government that appears to have lost its bearings. That requires representatives and senators to be better prepared to win important battles. Everyone in the senate chamber could have left on Tuesday having been given a more detailed picture of the depth of criminal corruption in our state, and a reason to take it more seriously.

Would it surprise anyone that another opportunity to do so was lost?