It finally clicked with me. I remember a neurosurgeon friend of mine explaining the problems of Mainecare (Maine Medicaid) to me. Even though his bills to Mainecare were pennies on the dollar, he was still never getting paid. When he did get paid it would come in the form of a check that didn’t even make sense. There would be no reference to what patient the money was to be applied. I also heard from other doctors, as well as read in the local paper, how the state government had overpaid physicians for Mainecare. Again this didn’t make sense as they owed doctors and hospitals so much that there was no way they could “overpay” them. I kept thinking to myself, “How stupid can our state government be?” as the headlines announced that they were asking doctors for the money back. Then I read this piece about Medicaid Money Laundering in the WSJ and I got a pit in my stomach. The scam is this: the federal government will match as high as 83% of each state’s Medicaid tab each year. Each state determines eligibility for this entitlement program. The state then overpays doctors, hospitals, etc and gets the federal government to reimburse it. Once they get this money they ask the health care providers to pay it back the overpayment.
Why isn’t anybody screaming about this method of gouging the taxpayer? The Governors of each state won’t because they get to use this cash to meet their budget as well as make themselves look good. All attempts at controlling this scheme have led to roadblocks in Congress. No, my state government wasn’t stupid in their payment methods to my friend or any other doctor or hospital. They were just crooked and we are all paying for it. I just wonder how Congress can discuss the concept of Medicare and Medicaid fraud and abuse by doctors and hospitals with a straight face while they continue to allow states to do it right under their growing noses.