Last month, SHIFT reported that top officials from the Centralia School District (CSD) committed fraud in management of the Medicaid Administrative Claiming (MAC) program—a program that “reimburses schools for time spent for referring eligible students and their families to Medicaid.” After interviewing over 50 witnesses, the state Attorney General’s office found that the district “knowingly filed scores of false time study forms to obtain MAC reimbursement payments it was not legally entitled to receive.” Investigators found over 200 instances of fraud.
CSD officials implicated in the Medicaid fraud have faced little to no repercussions. In fact, four of the five disgraced officials have already found new positions in other school districts. The outrageous circumstances surrounding the level of fraud—and the lack of consequences—begs the question: Why do programs that invite fraud—programs like MAC—even exist?
Dr. Roger Stark of the Washington Policy Center offers his insight in an article recently featured by Forbes. Stark writes,
“When Medicaid began, Congress assumed the program would remain limited because state legislatures would not want to increase the tax burden on their citizens. The exact opposite has happened. State lawmakers have doubled-down on Medicaid simply because of the extra federal money. If a state spends a dollar on education, it gets a dollar’s worth of education. If a state spends a dollar on Medicaid, it actually gets two dollars to spend because of the federal match. Consequently, Medicaid has exploded and is now one of the top three budget items for every state.
Through the years, states have used a number of questionable, but legal, methods of gaming the system to obtain more federal dollars. For example, the Medicaid Administrative Claiming (MAC) encourages teachers to inform their students and families about the insurance plan. Teachers can record the time they spend discussing Medicaid and then submit their time-cards to the state. The state pays the teachers for the time, adds the teacher expense to its overall Medicaid spending and receives matching funds from the federal government…
The fraudulent case in Centralia is simply one example that the structure and incentives in Medicaid are totally unreasonable and beyond common sense. America has a moral obligation to provide a government safety-net for those people who are truly in need. Medicaid, as it exists now, must be reformed, without gimmicks, to remain financially solvent and to provide quality health insurance.”
Like another healthcare policy with Democrats’ fingerprints all over it, you don’t have to dig too deep to find the cause of fraud, waste and abuse.