Congresswoman Michele Bachmann and Minnesota State Senator Sean Nienow recently commended the U.S. Office of Inspector General for stepping up the investigation into Medicaid rate setting in Minnesota. Both Bachmann and Nienow introduced legislation in 2012 requiring audits of Medicaid programs.
In a letter dated Nov. 20, 2012, The Office of Inspector General (OIG) at the U.S. Department of Health and Human Services, notified the Minnesota Department of Human Services that the OIG will audit the rates that were charged by health plans, “nonprofits,” to administer and pay Minnesota Medicaid claims on behalf of the poor and disabled.
Protecting Medicaid from fraud should not only be a Minnesota-specific goal, but a national one. Both the U.S. Congress and the Minnesota Legislature held hearings in 2012 on the need for greater transparency and accountability as calls for Medicaid auditing were made by federal and state lawmakers like Bachmann and Nienow.
“Taxpayers have been paying huge sums of money to health plans without ever getting an itemized list of what the money was for,” said Bachmann. “It is time that we find out, once and for all, why the health plans have been amassing huge reserves, and at the same time, increasing the rates they charge for paying Medicaid claims. When Medicaid money is lost through waste, fraud and abuse, the very people who need it don’t get the care they should. It is unconscionable to do nothing and leave our poor suffering in the wake of inadequate access to care.”
“Future rates are determined based on previous years’ costs, and the Affordable Care Act includes a vast expansion of Medicaid. We simply lack verifiable claims data to support what the health plans have been charging. This problem exists at every level, all the way to the top including the MN Department of Health, the Centers for Medicare and Medicaid Services, and the U.S. Department of Health and Human Services,” said Sen. Nienow. “A proper audit at the granular level is what is needed. People are finding it difficult to get services and providers suffer low reimbursements for the care they give. Proper audits will go a long way to restore integrity to these programs which, hopefully, results in better care for Minnesota’s poor families.”
Earlier this year, Bachmann introduced The Medicaid Integrity Act of 2012 calling for independent, third-party financial and performance audits every other year of the health plans who administer Medicaid.
Senator Nienow authored legislation in 2012 to implement audits of payment data and administrative expenses after discovering that no such audits have ever been performed in over a decade.