The Oklahoma Health Care Authority (OHCA) is an agency that was created here by the corrupt Governor David Walters in obeisance to the just-elected Bill Clinton’s regime. In anticipation of Hilliarycare’s passage, the OHCA was to act as a state “exchange.” Sound familiar? Rather than disappear with the failure of Hilliarycare’s passage, it has, like virtually all state and federal programs grown exponentially, now with an operational budget of almost 40 million dollars. This agency took over the administration of Medicaid from the state Department of Human Services and now administers this 5 billion dollar mess.
I thought at the time that Walters pushed this agency’s creation through the state legislature to secure some kind of healthcare spot in Washington for himself as a reward for being the first to take this step. Interestingly, our current governor is waiting until the presidential election results are in before declaring whether or not she will support setting up an Obamacare “exchange” here in Oklahoma. Walters and his old pals, including recently-returned state Medicaid director, Dr. Garth Splinter (no libertarian), probably find all of this very amusing.
The OHCA is recently in the news, having approved the hiring of a RAC auditor. RAC (not unlike a kick to the groin) stands for Recovery Audit Contractor. These “contractors,” whose hiring is required by Uncle Sam, audit Medicaid claims and identify overpayments to “providers,” receiving a commission for the amounts they declare as overpaid. If you are thinking that they are inclined to overstate “overpayments to providers” you get a gold star.
Physicians and facilities that are exposed to this type of shakedown will be effectively denied any appeal if they feel falsely accused, as the expense of battling these accusations will be daunting and the legal and financial resources of the government contractors will be unlimited.
What do you think physicians will do now that the pathetic Medicaid reimbursement, far below the market-clearing price for physician services already, is matched with the threats of RAC audits? If you think physicians will be even more inclined to rid their practices of Medicaid patients, you get another gold star.
Isn’t this classic central planning? Only government could come up with an anti-fraud program that would serve to eliminate access to health care. The politicians look good “cracking down” on fraud, the director of the OHCA publicly opposes the RAC audits and the scarlet letter of “Medicaid” becomes all too real for its victims. Physicians will be vilified for denying care, acting as scapegoats for these bureaucrats. This is going on with Medicare, as well, payments withheld from physicians and facilities for routinely over a year and once again, the denied amount forming the basis for the “contractor’s” commission.
No one is talking about the most obvious Medicaid fraud of them all, the payment relationship between the OHCA and the “not for profit” hospitals. Medicaid payment to these hospitals far exceeds the prices we have listed on our website. If you then add in the “uncompensated care” padding and the “provider tax” kickback the OHCA pays these big hospitals, the payment in excess of our displayed prices is stark.
Seems to me like the real fraud is that while the OHCA and Garth Splinter’s Medicaid bankrupt the taxpayers with these fat payments to their hospital pals, cheaper and I believe better care is provided just down the street at our facility. Preserving favors for their pals, erecting barriers to care for the poor. A classic lesson in government corruption and incompetence. The RAC bunch doesn’t make any money from this, though.
G. Keith Smith, M.D.