There’s some self-back-patting on Twitter this morning about the Republican idea introduced by Sen. David Sanders to put an office of Medicaid inspector general in the governor’s office.
The state Department of Human Services already looks for fraud in the giant program. The attorney general has a whole division devoted to Medicaid fraud. The U.S. government has a significant anti-fraud arm and an inspector general for that area.
Does creating a new state bureaucratic office — at least at SOME cost — really provide further assurances to Arkansas taxpayers? Or is it more style-over-substance posturing, which the self-important Sanders has become famous for? And needless, expensive government creep at that?
Since a Republican wants to grow government, he’ll undoubtedly get to grow government. Just as when a Republican wants to raise taxes on cell phones to funnel money to rural phone companies (see the bill by Sens. Jonathan Dismang and Michael Lamoureux, who’s been an attorney for rural phone companies) then the Grover Norquist no-tax pledge is no longer operative.
But I’d argue that the inspector general will be a mostly meaningless effort unless significantly more money is spent — either on a real staff for the office or the money to spend on outside investigators. And then comes the question of subpoena power and other complications.
Want an example of how this kind of Mom-and-apple-pie idea can sound good and produce zilch?
Remember Gov. Mike Huckabee? Remember the state fraud hotline? Remember Bill Hardin, the former FBI man Huckabee hired to gumshoe leads? All this followed the Nick Wilson scandal. Maybe you remember. Now: Do you remember any substantive good that came of that new job in the governor’s office and the hotline?
Again: the real fraud in Medicaid isn’t chump change ER visits by somebody who doesn’t qualify for Medicaid or hiding assets to keep the state paying for granny’s nursing home. It’s vast fraud by medical care providers, drug companies and insurance companies. It takes real sophistication, teams of investigators, subpoena power, time and lots of money to root out.
PS — Of course you need more government given the massive Obamacare expansion Republicans have now rebranded as their idea.
UPDATE: I talked with Sen. Sanders. He’s softened me somewhat, against all odds. He insists he understands the greatest magnitude of Medicaid fraud, or inefficiency, is on the provider side. He said he envisions not, new workers, but a transfer of existing oversight workers in DHS to a a more independent place under the governor’s direct control. He says Gov. Beebe is supportive. He said he’s followed a model that has been used in many other states, including New York. He says the state can enhance its reimbursement by more effective oversight of the program to root out improper payments.
Execution is everything.