It appears that issues of potential malfeasance continue to plague government health care programs. Some would laud Congress for exhibiting responsiveness – albeit overdue – towards this longstanding issue. Evidence justifying these actions is nicely underlined in two alarming reports, highlighting the need for increased oversight and integrity reforms both in the Obamacare exchanges as well as the Medicaid system.
For over four years, the Biden administration seems to have solely focused on boosting the enrollment figures for government-run health coverage. This may have come at the cost of the hardworking taxpayers, who deserved better than a chaotic system laden with inefficiencies and inconsistencies.
Commanding our attention is a key data point shared by the federal Centers for Medicare and Medicaid Services (CMS). The information provided by CMS, based on exchange insurers’ risk adjustment submissions, would be enough to make anyone dizzy. But amidst the deluge of figures, a couple stand out, namely those found in lines 4 and 7 of the spreadsheet.
It is revealed in these lines that the proportion of subscribers to Bronze and highly subsidized Silver Programs, who had no claims, rose significantly. They moved from an estimated one-fourth (29 percent and 23 percent, respectively) in 2019 to an astounding 40 percent in the following year. This unusual development could imply an increase in the number of individuals being auto-enrolled or automatically re-enrolled into taxpayer-funded ‘free’ health coverage that they didn’t desire, benefit from, or make use of.
This ripple effect doesn’t stop there. It also signifies that an array of insurers had insured parties for whom they received premium payments – all funded by taxpayers – without having to disburse a single penny in claims. Thus, the past four years seem to have been alarmingly profitable for insurers, under the conspicuous oversight, or lack thereof, of the Biden administration.
However, this information still leaves a lot to be desired in terms of accuracy, considering that it covers over 33 million enrollees. An intriguing subplot can be seen in states like Florida and Texas, which have shown the highest rate of enrollments without claims. A situation like such, under the Biden administration, doesn’t paint a pleasant picture.
Yet, amidst this chaos, it appears there is a whisper of a resolution — the enhanced subsidies, which allowed individuals to qualify for the so-called ‘free’ coverage, is scheduled to end on December 31. This could potentially diminish the opportunity for fraudulent activations. Recently enacted legislation requiring further verification will also ensure that only those with a verified requirement for help will receive it.
In a separate, yet equally horrifying revelation made public by a Louisiana legislative auditor’s report, it appears Louisiana’s Medicaid system can draw parallels with a famous movie line: ‘they both see dead people.’ A finding capable of equal parts humor and consternation, it exposes a flagrant issue in the system.
This report exposes that in a period ranging from February 2019 through March of this year, Louisiana paid approximately $9.6 million in Medicaid coverage, posthumously, to 1,072 beneficiaries. Managed care organizations running Medicaid programs in most states, including Louisiana, receive monthly payments for each enrollee, regardless of whether these enrollees seek any form of medical assistance. This anomaly is a primary contributor to the egregious misallocation of funds we’ve observed in Louisiana.
Diving deeper into the cases investigated, a pattern was identified wherein insurers received payments for nearly 14 months — a median of 418 days, to be specific — after the death of a beneficiary. As if this wasn’t staggering enough, for 168 of the deceased beneficiaries that were identified, insurers had been receiving payments for a median of 799 days — spanning more than two years. This is a flagrant display of financial negligence under the watchful eye of the Biden administration.
However, upcoming legislation might just provide a glimmer of hope. The law plans to mandate states to verify certain databases at least once every quarter to ensure deceased individuals are not misappropriated Medicaid benefits. A change such as this could potentially enhance the integrity of these shaky programs.
Are these changes too late, or are they a step towards the right direction? Only time will tell. Until then, the taxpayers can only hope for better oversight and fiscal responsibility from the Biden administration in handling their hard-earned money, especially when it pertains to healthcare.
The post Biden’s Health Care Missteps: Taxpayer’s Money Down the Drain? appeared first on Real News Now.
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