Medicaid fraud not surprising

An AP article on Jan. 13 informed us that our state spent more than $406 million on improper Medicaid payments according to a federal audit. In addition, the state’s eligibility error rate is nearly three times the national rate of 3.6 percent. Health and Human Services director, Tony Keck, blamed much of the problem on his own eligibility workers, who did not follow procedures to enroll people in the program with proper documentation. His flippant explanation for deficiencies in a program that has been operating in this state since 1968 is that “we’ve got to be able to walk and chew gum at the same time.”

As a former director of this agency, I can attest to the fact that there is another side to the story: simply, you get what you pay for. This agency has had significant budget cuts and staffing cuts for several years. The caseload has dramatically increased because of the poor economy. Eligibility staff is overwhelmed. Given how the state currently funds and manages this program, the surprising finding is that the audit exception is not more. We expect this diminished staff to handle a growing caseload with fewer resources and yet maintain the same quality of services. Most businessmen know what that formula produces: errors, poor morale and poor customer service.

If the state is going to provide this program or any program at the current level of services within tolerable error rates, then it must invest in the staff to do it right. If you are very ill, you don’t go out looking for the cheapest doctor you can find. You look for the best and pay the bill. If you are looking for a financial adviser, you don’t put it out for bids. You look for proven performance and pay the bill. If you do not invest in adequate numbers of quality staff to run a government program you will still pay the bill – in waste and audit exceptions that must be paid back with state funds – but have little to show for it.

As most of us learn in life, you really do get what you pay for. This rule holds true for the quality of government that you get for your tax dollar. If you want quality government, you must attract quality professional employees through a combination of pay, benefits and work environment. This is an investment in the future of our state. If this is not done, and we are now dangerously close to jeopardizing this, then future errors and waste in government will make the current $406 million audit exception seem like the good old days.

The writer, a former director of the state’s Department of Social Services and Department of Health and Human Services, lives in West Columbia.