I have called on the General Assembly to pass strong legislation targeted specifically at Medicaid fraud to build on the $139.7 million in savings we have already uncovered. The Senate has already passed strong anti-fraud legislation to give the state the same tools as the federal government to fight Medicaid and Medicare fraud. The legislation's opponents claim the bill, which I support, is too harsh. How can you be too harsh on those who knowingly commit fraud, steal from taxpayers and rob our most vulnerable from assistance they truly need? One phony argument made by opponents is that the bill will go after well intentioned doctors who make a mistake. This is not true. The legislation is clear that we are going after only those who knowingly commit fraud.
The argument cited by the governor in that quote has been pushed by Rep. Rob Schaaf, R-St. Joseph, who made sure the bill didn't even emerge from his committee for a vote by the full House. Schaaf says he, too, is in favor of eliminating fraud, but is seeking a compromise that won't affect innocent doctors and keep physicians from participating in the Medicaid program.
He expressed his thoughts on the issue in a news release last week:
Jefferson City - Physicians, long-term care providers, and billing specialists painted a dire picture before the House Special Committee on Healthcare Facilities yesterday. Most indicated no opposition to finding ways to prevent Medicaid fraud. However, healthcare providers said if legislators don't exercise caution in crafting and passing Medicaid fraud legislation, they and many of their associates would be compelled to leave the Medicaid program or the state, exacerbating an already acute access problem for Missouri's needy citizens.
Several physicians have left the Medicaid system already or no longer accept new Medicaid patients because of the program's relatively low reimbursement rates and excessive bureaucracy. The added risk of an overly broad and excessively punitive fraud measure would only compound the struggle to attract and retain the physicians needed to maintain Medicaid services in Missouri.
"It's hard for physicians to [stay] in the program in the first place," said Dr. Charles Van Way, Truman Medical Center Chief of Surgery. "A major threat like this is going to push a lot of them out."
Physicians noted Medicaid reimbursement rates, ranging from 11-35Â¢ for every dollar of care given, provide a significant disincentive for staying in the Medicaid program. The disincentive is so great that specialists are opting out of taking Medicaid patients, creating a serious access problem.
"There's a shortage ... in the greater Kansas City area of specialty care for Medicaid patients," said Dr. Robert Gibbons, president of the Metropolitan Medical Society for Greater Kansas City.
Lack of access isn't limited to medical services. Dr. Matt Niewald, a dentist in Lee's Summit indicated that children could have to wait weeks and travel up to two to three hours for dental care through Medicaid.
Those testifying took issue with proposed legislation, including provisions that would crack down on honest mistakes--like entering in a billing code one digit off of the correct code--and that would give undue incentive for whistleblowers without imposing a penalty for filing a frivolous charge. They also stated that the inclusion of a private cause of action, which allows private attorneys to bring suit on behalf of the state and was included in the Senate version, would line trial attorneys pockets while inadvertently lessening access to medical care people need.
In the wake of their concerns, healthcare providers indicated support for a more refined approach. In the words of one physician, rooting out provider fraud is like cutting out cancer: you do it "with a scalpel...not a bludgeon or a meat ax." First, participants were fairly unanimous in their call for legislation that punishes those with clear intent to defraud and protects those who make honest mistakes. Some believed whistleblower incentives would poison doctor/patient trust. Others believed they would be helpful. Most expressed support for suits filed through the attorney general, not private attorneys. The committee's chair, Rep. Rob Schaaf (R-St. Joseph), believes input from the hearing will help the committee find middle ground on fraud legislation.
"We heard a lot of fear on behalf of Medicaid patients," said Rep. Schaaf, "that they would be hurt if we're not careful. Having heard that makes me more hopeful that we can convince the Senate that we can work together to craft a bill that would be helpful without hurting Medicaid patients."
And, in the end, a workable compromise is the hope not only of the committee but also of Speaker Rod Jetton (R-Marble Hill) who spoke to the committee prior to the beginning of testimony.
"The last thing we want to do is pass a fraud bill that causes [doctors] to drop out of the program or quit seeing [Medicaid] patients," said Speaker Jetton, "because that would be detrimental to the folks who need those services..."
Speaker Jetton commended the committee for seeking "the middle of the road."
Schaaf singlehandedly put a brake on the legislation this year and held hearings recently soliciting testimony that wasoverwhelminglyy against the legislation.
As The Turner Report has pointed out, Schaaf is not exactly a disinterested observer as far as this legislation is concerned. He is a physician and most of his campaign money comes from medical sources.
Too many times we have seen much needed legislation derailed because one special interest or another tells us it won't have the intended effect. Usually that warning is accompanied by an implied threat that services will not be available at all. Nearly every time those warnings have been ignored, the legislation does not end up having the dire effect its opponents had warned us against.
Once more, this shows us how the narrow interests of a well-heeled majority with friends in high places can work against the greater good.