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Governor Perdue waltzed over to Rex Hospital the other day and held a good old-fashioned photo-op (to boost her once again sagging poll numbers) and standing right there in front of the operating room in front of the cameras she morphed into Jesse Helms – announcing that one way or the other, come heck or high water she’s going to kick the cheats off Medicaid.
 
Now in one way Madame Governor’s come up with a brilliant stratagem – I can’t see one Republican criticizing her for booting the charlatans off Medicaid. But, on the other hand, a lot of the folks in her own party may be shocked by her reincarnation as Jesse Helms. Plus, when you get right down to it this whole affair looks suspicious.
 
For instance, Governor Perdue never mentioned a Medicaid fraud crisis until a few days ago. The whole thing came on like a sudden spring storm. It didn’t exist a year ago. Cynics may also wonder if the fraud crisis didn’t blossom as a result of the budget crisis and Secretary Lanier Cansler passing out $250 million in no bid contracts to his friends. The Secretary and the Governor overspent and now somebody has to pay the piper and laying the blame on Medicaid cheats sounds fine – except for one problem.
 
For some time the Governor and Secretary Cansler have been telling folks 45% of the Home Care Medicaid patients are cheats: Then, last month, Cansler finished running his analysis to remove the cheats and found out he was wrong: Cansler’s own study showed just 1% of the patients were skizzlers.
 
And there’s another small glitch – that may turn into a big and costly hole – in the Governor’s Plan: She’s hired “Big Blue” – IBM – to implement her Medicaid purge. According to the Governor, IBM’s going to run a computer program and tell her who’s cheating and she’s going to pay IBM 10% of whatever money the state saves once the scoundrels are cut. Which sounds like a good deal for taxpayers.
 
Except, unfortunately, the state’s contract with ‘Big Blue’ doesn’t say exactly what the Governor claimed at her press conference. In fact, IBM will get 10% every time what’s called a recoupment letter goes out – and IBM gets paid, quote, “irrespective of whether DMA [the state Medicaid department] actually recoups the money.”
 
In other words the state could recoup nothing – but still owe ‘Big Blue’ 10%. Which could turn out to be a mountain of cash.
 
Which leaves me wondering, puzzled, which would be worse news? Learning Medicaid is riddled with fraud and we’ve been skizzled for years. Or finding out it’s not – but having to pay IBM anyway.
 

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One comment on “Fraud and Politics

  1. -1 says:

    What I would like to see are some numbers. We have the no bid contracts. We have IBM. We have the Governor’s SWAT team. We are paying how much per RN to visit Medicaid recipients for initial assessments and re assessments? We have been hearing that 45% non qualifying number for over a year and now it is 1%? I am no accountant but all this spending to recoup 1%?

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