Friday, February 8, 2013

Medicaid audit released

Posted By on Fri, Feb 8, 2013 at 1:07 PM

The Arkansas Legislative Audit Division this afternoon released its special audit on the Medicaid program.

Here's the full report. Digesting it. But I see this. After several years of improvement in payment error rates, the audit for 2012 reported a big jump on some 149 cases sampled — to 14 percent with a cost of $389,000. But DHS said the criteria for case selection changed in a way that influenced that number. Also, the audit reports a lack of documentation in provider files to justify payments for in-home services that cost tens of millions each year. But DHS contends that Legislative Audit is calling for documents that aren't required.

This is but a sample of extended back and forth of a similar nature. It's a giant, complicated program. Mistakes, undoubtedly, have been made. Too early in my reading to find an obvious bottom line. Over the years, Arkansas has done better than the country as a whole on error rates. But if there's a slip in the opposite direction — something DHS seems to dispute — that's a cause for concern.

Bigger issue: Are errors a reason not to accept federal dollars to cover more Arkansas people with health care? Or merely a reason to run a tighter ship? I don't find support for refusing Medicaid expansion in the audit. The Republican spin will compare the error rate against the overall size of the program and suggest it makes all the spending suspect. Little evidence supports such a broad extrapolation unless all DHS responses are dismissed.

The report restates past findings publicized previously since 2009 as well as new findings for 2012.

DHS says its response are those contained in the audit. I checked in with Republican Rep. John Burris, often outspoken on medical issues, and he says he accepts audit's findings, whatever they might be, because he believes in the agency's integrity.

The governor's office notes that audit focused on a small group of high-risk Medicaid recipients three years ago and errors were corrected. Now, a different group is under focus. DHS welcomes that attention and will respond, accordingly Matt DeCample. But he noted that this group accounts for only 1,000 of more than 700,000 recipients, "a very small portion of overall clientele."

In the end, said DeCample, though the timing of the report was an unusual (if understandable given ongoing Medicaid discussions), "This ended up being far more of the traditiona, respectul co-operative effort between the bureau and DHS."

This is the audit pushed and shaped by Republican legislators anxious to gin up findings to support their case against expansion of Medicaid. It was set for a release announced only to in-the-know Republicans, but the Beebe administration's objection to extraordinary handling of the case, plus objections to methodology, prompted a delay. The Department of Human Services subsequently said it had been provided the customary opportunity — denied previously — to discuss findings with auditors in case amendments needed to be made.

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