Auditing Medicaid

Medicaid, the federal/state program that provides health insurance for the poor, is the Pac-Man of state budgets, rapidly gobbling up ever-larger shares of total outlays. It would be hard to find anyone — fiscal hardliner or advocate for the poor — who thinks Utah can just watch these escalating costs go on.

The conflict, of course, comes when those responsible for the overall burden on taxpayers move to limit the growth in spending by cutting services, excluding clients or otherwise harming the most vulnerable of our friends and neighbors.

A solution, as demonstrated by a new office within the Utah Governor's Office of Planning and Budget, is to crack down on miscodings, overcharges, doctor shopping and other practices that cost the taxpayers a lot of money but do nothing to heal the sick.

Last year, the Legislature created an Office of the Inspector General for the state's Medicaid program. Last August, Lee Wyckoff started work as the head of that office, supervising a dozen auditors and support staff. Last week, the governor's office reported that the OIG has so far clawed back $5.6 million in overpaid Medicaid provider claims and stands to save the state another $4 million in money that would have gone to questionable prescriptions.

And, the report says, there is another $20.5 million of relatively low-hanging fruit, most of it past overcharges for hospital visits, that should be in the mail soon.

Not that much, perhaps, out of a program that spends $1.8 billion a year. But every dollar that comes back, or isn't spent in the first place, is a dollar that simultaneously eases the burden on taxpayers and can go to provide necessary medical services for low-income Utahns, as provided by doctors and hospitals who stay within the rules.

It's certainly enough to justify the OIG's own operating budget of less than $2 million a year.

There is always a fear that if the OIG comes down too hard on perceived overcharges, providers will be even more reluctant than many of them already are to take Medicaid patients. And an auditor who knew nothing about medical services could throw the kind of spanner into the works that would really harm the sick and the infirm.

But, properly done, such oversight could actually improve medical services, by noticing individuals who scam doctors for excessive prescriptions or flagging patients who habitually seek treatment at emergency rooms when lower-cost services would serve their needs just fine.

This process does not solve all our problems with health care costs. But it's a good start.