Your Opinion: Pass bill to block false Medicaid claims
Sunday, April 13, 2014
Imagine if we had legislators who did not understand the fundamental differences between going to the grocery store (something you do when you need to buy food), and going to the doctor (something you do when you’re sick). Imagine the legislator compared getting health care to shopping with someone else’s checkbook and suggested that doctors bilk the system for their own profit (in spite of the fact that Medicaid pays less than the worst private insurance available.)
The difference between health care and grocery stores is stark and real. Most people like the grocery store. No one wants to go to the doctor’s office because no one wants to be sick. At the outset, Jay Barnes’ opinion April 6 on reforming Medicaid is revealed to be uninformed and ridiculous.
Our daughter is a pediatrician. I worked as a respiratory therapist for 13 years. Physicians order tests because they need information in order to properly diagnose and prescribe. They do not order tests to make money. First of all, the tests and the money generated by the tests goes to the laboratories and pathologists. Secondly, the results are used to plan and evaluate care. No physician tests for fun and profit.
Many pediatric patients on Medicaid do not have good nutrition, secure and sanitary living conditions, or structured nuclear families. Physicians often spend as much time teaching as they do prescribing. To suggest that patients and physicians conspire to loot the Medicaid system is a gross insult to physicians, and a lesser insult to those on Medicaid.
Is there fraud and abuse in Medicaid? Yes. Why hasn’t it stopped? Because the Republican Party has consistently and steadfastly blocked a State False Claims Act in spite of the fact that passing it would generate more federal funding for the state. The Federal False Claims Act returns billions of dollars to the treasury every year, money that is looted from federal programs by crooks and cheats of all stripes, including the rare physician who overbills. It depends on whistleblowers and pays rewards to those who blow the whistle.
But because the hospitals and health care organizations oppose this legislation at the state level, it doesn’t get passed. If Jay Barnes were serious about reforming Medicaid and stopping fraud against the state of Missouri, he would first understand the health care system is different from shopping at Walmart, and would push hard to see a State False Claims Act passed and implemented.