Ohio’s Medicaid office searched for ways to continue paying hundreds of healthcare services providers after uncovering “credible allegations of fraud,” violating the Affordable Care Act.
The state agency came up with “good cause” to continue funneling money to providers strongly suspected of fraud in 321 of the 401 cases that arose between July 2011 and June 2013, according to a report made public Tuesday by the Department of Health and Human Services inspector general.
The report may have implications for the political ambitions of Republican Gov. John Kasich who assumed office in 2011 touting his opposition to Obamacare, but then fought hard to expand Medicaid, as provided by the federal health program, in his state just two years later.
Conservatives blasted the governor for what they saw as a backdoor endorsement of Obamacare. Ohio received a $2.6 billion federal grant to extend Medicaid, as provided by provisions of Obamacare. Most, but not all, of Kasich’s Republican colleagues in the nation’s statehouses have resisted Obamacare by refusing to expand their state’s Medicaid operations.
The inspector general’s findings showed Ohio flouted a March 2011 Obamacare measure that “require[s] the state agency to suspend all Medicaid payments to a provider when it determines that there is a credible allegation of fraud.” Instead, Ohio suspended payments to Medicaid providers in just 80 of the 401 cases in which potential fraud was detected.
The state agency spent more than $96,000 of federal money reimbursing suspended Medicaid providers for claims filed before the date they were barred from participation in 24 of those 80 cases, “contrary to Federal requirements,” the inspector general said.
While Kasich argued in 2013 that rejecting the Medicaid expansion would simply send those taxpayer dollars to other states like California, a Jan. 30, 2015, Congressional Research Service report found that if federal funds aren’t spent on Medicaid expansion, they aren’t spent at all.
“If a state doesn’t implement the ACA Medicaid expansion, the federal funds that would have been used for that state’s expansion are not being sent to another state,” the congressional report said. “There is not a set amount of federal funding for Medicaid. Each states gets the federal funding necessary for their Medicaid program.”
The Congressional Budget Office noted in 2012 that allowing states to opt out of Medicaid expansion — which came about as a result of a Supreme Court decision that made that provision of Obamacare optional — reduced federal spending by nearly $300 billion.
Kasich is expected to press his state to renew the Medicaid expansion in the budget this year, when the $2.6 billion federal subsidy runs out.
