Political Horizons: Medicaid fraud fight between GOP and Edwards administration comes to head this week

March 31-- Mar. 31--Incumbent Democratic Gov. John Bel Edwards, in absentia, took it on the chin when his Republican challengers gathered last week on the same stage for the first major forum in the gubernatorial campaign.

U.S. Rep. Ralph Abraham, of Alto, and Baton Rouge businessman Eddie Rispone listed for the friendly crowd at the Pelican Institute for Public Policy event what they called Edwards' shortcomings, including the expansion of Medicaid.

Within days of taking office in 2016, Edwards ordered that the government-paid health insurance program raise its income-based eligibility requirements, which has allowed nearly a half million previously uninsured or underinsured people access to the government-paid health insurance program.

Republicans claim a recent legislative audit shows millions have been spent on people who make too much money and shouldn't have been enrolled. "The taxpayer is getting hosed over and over," Abraham told the luncheon audience.

It's a potent issue likely to come to a head this week when the Republican-majority Legislature will be given the opportunity to subpoena the Edwards administration for the tax return information that could show just how many Medicaid enrollees reported making too much money to qualify.

Legislative Auditor Daryl Purpera issued a report in November suggesting the state paid up to $85 million over 20 months on providing health care coverage for such people.

He asked the Department of Revenue through the Task Force on Coordination of Medicaid Fraud Detection & Prevention Initiatives for statistics from income tax returns, which he says would provide better calculations than using wage information.

But Revenue Secretary Kimberly Robinson has refused, citing state law that she says opens her to criminal prosecution for releasing information about filers who claim a certain income on tax returns and different income on Medicaid applications. The definitions for income on the two forms differ.

Attorney General Jeff Landry, a frequent Edwards critic, issued an opinion last week saying Robinson misinterprets the law, noting that Purpera is asking for statistics in income ranges that are gleaned from tax returns -- not the identities of the taxpayers. Purpera said he would present Landry's opinion on Tuesday to the Legislative Audit Advisory Council, which has the power to subpoena the Revenue Department for the statistics.

But the issue goes beyond Landry's most recent opinion and Robinson has asked Landry for some clarifications. Another opinion issued about a year ago determined that tax information could not be used in an audit. It's not merely statistics but taking information from one entity, the Louisiana Department of Health, and comparing that to information on personal income tax returns, which sounds a lot like an audit, she said. Some legislators have repeatedly tried to pass a bill that would add the Legislative Auditor and others to the exemptions of that state law. The bills have been repeatedly rejected.

Robinson said this is an end-run around existing law to make a point about Medicaid expansion. "This is about politics," she said.

The image that bothers critics is of thousands of dastardly scofflaws ripping off hardworking patriots to exploit those sweet Medicaid benefits.

And while certainly a few providers have floated paper for work they didn't do and a handful of enrollees may have sold their prescription medicine, the big numbers that so enrage the base come from people making too much money to be enrolled in Medicaid. And that's an unintended consequence of Republican Gov. Bobby Jindal privatizing Medicaid administration.

Medicaid is insurance coverage for people who meet specific income criteria based on the size of the family --$28,680 for a family of three.

A few years ago, the state-federal program paid doctors, hospitals and clinics directly for services provided. Now, the state pays private companies by head count to provide "managed care," which is supposed to give patients a more holistic treatment plan.

In the past, if Medicaid enrollees got a job or a promotion with earnings that exceeded specifications, perhaps even got coverage through their new employer, they'd just stop using Medicaid. No services, no additional tax dollars spent. But under the new "managed care" system, the state continues to pay the private companies as long as the person remains on the rolls, even when that person is no longer qualified and probably isn't using Medicaid anymore.

Say there are 1,700 people who paid taxes on incomes over $100,000 a year but are still on Medicaid rolls. That's about $1 million wasted dollars. Publicly acknowledging that many $100,000 recipients still on Medicaid rolls -- and being paid for by the state -- would no doubt launch an avalanche of criticism directed solely at Edwards.

But you also can bet those pushing this agenda won't be saying: "Oops, didn't consider that when we all supported privatization a few years back."

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