“Our new Constitution is now established, and has an appearance that promises permanency; but in this world nothing can be said to be certain, except death and taxes,” Benjamin Franklin wrote in 1789. But perhaps we should add improper government payments to that unfortunate list.
The U.S. Government Accountability Office released more reports last month on the perpetual problem of government payment errors, this time within the Medicaid program, and the results were, yet again, depressing.
The mammoth program, which covers 70 million people, had a budget of $576 billion last year, and made $346 billion in total payments. Unfortunately, $36.3 billion of those payments were improper — an error rate of 10.5 percent.
And, despite ongoing efforts to improve data quality and eligibility screening, the problem is getting worse, rising from a 9.8 percent error rate in fiscal year 2015.
“We and others have expressed long-standing concerns about the completeness, accuracy and timeliness of available Medicaid data, and the effect of these inefficiencies on [the Centers for Medicare and Medicaid Services’] ability to ensure the fiscal integrity of the program,” the GAO scolded. “CMS’s continued reliance on inaccurate, incomplete and untimely data, and the ongoing uncertainty about the scope and Pashacasino timing of its remedial actions, is inconsistent with federal internal control standards. As a steward of the program, CMS must take immediate steps to ensure the appropriate use of scarce federal and state dollars.”
Or else what, though? It is extremely unlikely that any heads are going to roll for such ongoing mismanagement. That accountability has always been the problem with government programs, particularly the very large ones.
President Donald Trump and House Republicans have suggested converting Medicaid to a block grant to states as part of their Obamacare reforms. Though block grants are not a panacea, and large states like California would still struggle with many payment errors, devolving power to the states could help reduce waste and fraud, while eliminating a layer of bureaucracy and offering the states more flexibility. Besides, given Medicaid’s record, the program is long overdue for a shake-up.
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