Ill. to check for Medicaid fraud without federal OK
SPRINGFIELD – Gov. Pat Quinn’s administration will start combing records for Medicaid fraud without the federal government’s approval.
State officials told aides to President Barack Obama this week that they are moving forward after waiting nearly a year for the go-ahead.
“We have to reduce expenditures there,” Quinn said Friday during a stop in Springfield. He has pledged to cut $2 billion from the program that provides health care to 2.7 million poor and disabled Illinois residents,
Healthcare and Family Services Director Julie Hamos wrote in a letter to the U.S. Department of Health and Human Services that her agency will start checking the addresses of Medicaid recipients against driver’s license records to ensure they live in Illinois. Another plan to verify income eligibility is forthcoming.
Federal officials have expressed concern that the plan is at odds with Obama’s health care access law that forbids states from making it harder for low-income residents to get Medicaid coverage.
But Democrats in the Quinn administration, under pressure from Republicans to enact reforms to save money, say they can’t wait any longer. Lawmakers approved changes – including a crackdown on fraud – in January 2011, and Hamos said Washington continues to stall state efforts.
“We are moving forward to implement new procedures that are essential to the integrity of our programs,” Hamos wrote to a federal Medicaid official.
The letter said that verifying residency is crucial to the state’s program. It said that of medical information cards returned as undeliverable in November alone, 6 percent – or as many as 6,000 – came back indicating the intended recipient has an out-of-state address.
Illinois Republicans pointed to the figure as evidence the state’s Medicaid program could have hundreds of millions of dollars of fraudulent spending.
Sen. Dale Righter, R-Mattoon, criticized Quinn last week for dragging his feet on the reforms and Obama for making Medicaid too easy to get.
“It’s the very provisions of the Affordable Care Act that the president is saying is going to help get rid of fraud and abuse that are standing in the way of trying to root out fraud and abuse here in Illinois,” Righter told the Chicago Tribune, which first reported the Quinn administration’s move.
Hamos said she was not responding to GOP criticism and her agency released a chronology of events, beginning with the state’s late-April request for guidance from the federal government on implementing its reforms.
She said the state complied with a federal request to set up an electronic system to ensure Medicaid recipients do not earn more than they’re allowed, but that U.S. officials still balked. The agency is working with the Revenue Department to be able to review income tax returns and use other electronic databases to check wages.
In a statement, the Department of Health and Human Services said it requested additional information on Illinois’ plans and is reviewing that response.
“We are committed to giving Illinois and all states the ability to maintain the integrity of their Medicaid programs while ensuring that beneficiaries continue to receive access to the care they need to live healthier lives,” the statement said.
