If a person dies will taxpayers be liable for the cost for health insurance that is backed by the government?
In any scenario that involves private sector the answer would be evident. But in government? It’s an ongoing issue which is costing Americans thousands of dollars.
Recent reports have revealed 450,000 Medicaid payments, totaling close to $250 million, on behalf of those who are dead. These aren’t deferred reimbursements or leftover administrative costs. They are ongoing monthly payments directed to managed-care companies (MCOs) for a long time after the death of beneficiaries.
This isn’t a simple glitch in the clerical system. It’s part of a bigger problem: systemic fraud, inefficiency, and abuse which drains billions of taxpayer dollars from both state and federal programs each year.
Dead Enrollees, Live Payments: How the Medicaid System Enables Waste
Over 85 percent Medicaid beneficiaries, which is more than 83 million people, are registered in private managed-care companies which pay an annual fixed amount for every participant. The payments are intended to pay for medical care as well as routine care.
However, in the hundreds of thousands instances the government continues to pay insurance companies even after the person who enrolled is dead..
It’s not a neglected gym account. It’s a transfer that’s approved by the government in the millions in services that can’t be utilized.
The result is absurd?
A “cradle-to-grave” social program that surprisingly extends well beyond to the cemetery.
A Fix That Could Be Implemented Tomorrow
The most annoying thing is how easy it is to find a solution.
The federal government maintains an exhaustive record of deaths in the Social Security Administration’s Death Master File and the states maintain their personal vital statistics database. The process of checking these records monthly – not annually and not quarterly, would immediately stop any fraudulent payments.
This is the norm in federal programs as well. The data is there. Technology exists. The only thing missing is the willingness to apply it.
Republicans as well as President Trump recently imposed quarterly death records checks for Medicaid However, the change will not be in force for a while, until 2028. States must not put off the process. Checks for the month could be issued immediately to save money and restore the integrity of the program even before the federal mandates take effect.
COVID Exposed Just How Much Fraud the System Can Sustain
The COVID-19 pandemic was the most precise demonstration about what occurs when the eligibility check is suspended:
- 400 billion in fraudulent and improper payment
- 27 million people are found to be ineligible for welfare benefits
- Benefits for months or years given to those who were not entitled to these benefits.
The eligibility checks are important. If they’re not checked, or ignored, the waste is exploding.
Restoring Integrity: The Path Forward for States
The federal reforms are encouraging states to take on charge and take responsibility for Medicaid supervision. There are tools available:
Reforms to the state that are able to be implemented immediately
- Every month, cross-checks are conducted against death records from both the federal and state
- Eliminating auto renewals of Medicaid coverage
- Pre-populated enrolling forms, which promote rubber stamp approvals
- Notifying promptly of life events like relocation, death or shifts in income
These steps are simple and have been proven to be cost-effective. In addition, they guarantee that Medicaid funds go to the most in need and not to insurance companies who collect money for the deceased.
Welfare Integrity Doesn’t Have to Be Optional
The loss of billions of dollars shouldn’t be viewed as being the “cost to do the business” in government programmes. It is the American taxpayer deserves better, and the safety net is dependent on it.
With the introduction of new federal welfare integrity laws and a strong leadership from Congress as well as the Trump administration The process of removing the long-running abuse and waste is in progress. However, states must complete the task.
Restoring accountability, making sure that eligibility standards are enforced and making sure that beneficiaries are in fact, alive, are not radical reforms. These are simple actions that will protect taxpayers and vulnerable families who depend on Medicaid.
The system is able to work. It’s just that it requires to be handled cautiously, and with a sense of responsibility.
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