Two months ago, The Washington Examiner emphatically criticized the state of Maryland for paying $7.5 million in Medicaid benefits to 532 dead people. More recently, an audit by District of Columbia Inspector General Charles Willoughby confirms that the same bureaucratic incompetence and apparent fraud has also been going on in the District, where dead people collected $663,000 in health care benefits in 2009. Federal investigators say Medicaid providers may have overbilled the D.C. Department of Health Care Finance by as much as $22.6 million during that same year.
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Jointly funded by the city and the federal government, Medicaid pays for health care to 145,000 low-income and disabled residents, 61 percent of whom are children. It is also D.C.’s largest source of federal funding, $1.1 billion annually, which makes it a tempting target. According to federal law, D.C. is required to “maintain an accounting system and supporting fiscal records to assure that claims for Federal funds are in accord with applicable Federal requirements.” But the department’s accounting system somehow failed to stop Medicaid payments for a patient who had died nine years earlier. Nearly $4 million was paid on claims lacking valid Social Security numbers. The DHCF blamed a clerk’s “fat fingers” for a $5.6 million payment on a $100 claim – one of the few 78,361 overpayments actually caught before the check went out.
Merely checking claims against the Social Security Administration’s database and Death Master File, which is updated monthly, could have prevented these losses — and they are only the low-hanging fruit. Five years after Harriette Walters was caught embezzling $50 million from the D.C. Tax Office, auditors found that DHCF still did not have management procedures in place requiring supervisory review of all Medicaid payments requiring manual input. “As a result, [the District] could not be assured that Medicaid claims paid under these conditions were valid,” auditors noted. Since the audit only covered payments made to private medical providers, not D.C.-owned facilities or managed care contractors, the full extent of the problem remains unknown.
Is it just a coincidence that DHCF was Mayor Vincent Gray’s dumping ground for former mayoral candidate Sulaimon Brown, who briefly worked there as a $110,000-a-year special assistant before a public outcry forced his dismissal? Or that this week, federal authorities raided the homes and offices of Jeanne Clarke Harris, who did work for Gray’s 2010 campaign, and political donor Jeffrey Thompson, who is still the city’s top Medicaid contractor even though he paid $12 million in a 2008 settlement for overbilling the program?
