Quinn to Obama: Illinois moving ahead on Medicaid fraud crackdown

By Ray Long and Alissa Groeninger Clout Street
7:56 p.m. CST, February 9, 2012

SPRINGFIELD— As President Barack Obama presses forward with his signature health care law, his fellow Illinois Democrats running state government have waited more than a year to win federal approval for a new plan to fight fraud in the health program for 2.7 million of the state's poorest residents.

Facing increasing Republican pressure to put reforms in place, this week Quinn’s team told the Obama administration that Illinois will wait no longer.

Later this month, the state’s Healthcare and Family Services Department will start matching addresses of people enrolled in Medicaid against Illinois secretary of state driving records to ensure that care for the poor is going to people who actually live in Illinois. The Quinn administration also is putting together a plan to check income eligibility and plans to roll it out soon, officials said.

The push to tighten access to Medicaid was part of a reform plan lawmakers approved in January 2011. The law required a month’s worth of pay stubs to verify that a person’s income is low enough to receive Medicaid. Only one paycheck had been needed before, and lawmakers thought that opened up the program to fraud. Officials also sought to tighten requirements for proof of residency, such as wanting utility bills or rental documents, but the law does not give specifics.

But Obama health care officials balked, saying Illinois’ new requirements violated tenets of the president’s high-profile U.S. Affordable Care Act that hold no state should make it harder for people to sign up for Medicaid. The Obama administration also maintained that matching names electronically is the best way to verify eligible Medicaid participants and urged the state to use that method.

Julie Hamos, director of Quinn’s Healthcare and Family Services Department, said Illinois set up the electronic matching program and the federal bureaucrats put up more hurdles.

“We just said, ‘That’s it,’ “ Hamos told the Tribune Thursday. “We are going to implement this.”

In a letter sent to the Obama administration this week, Hamos wrote that nearly 6 percent — or about 100,000 — medical identification cards sent to households were returned to her agency as “undeliverable with out-of-state addresses.”

That number shocked the state’s Republicans. They pointed to the figure to buttress their belief that potentially hundreds of millions of dollars of fraud exists in the state’s Medicaid program. Republican lawmakers contend the Quinn administration should have acted faster and pushed the Obama administration harder.

“Here you have the president of the United States who trots around the country, back when he’s selling the Affordable Care Act, or Obamacare, as the answer to all our ills when it comes to fraud and abuse,” said Sen. Dale Righter, a Mattoon Republican and onetime Obama colleague in the Illinois Senate. “It’s the very provisions of the Affordable Care Act that the president is saying is going to help get rid of fraud and abuse that are standing in the way of trying to root out fraud and abuse here in Illinois.

Righter and Republican Rep. Patti Bellock of Hinsdale, both convention delegate candidates for Republican presidential candidate Mitt Romney, charged the Quinn and Obama administrations with foot dragging during a Springfield news conference last week.

Hamos, however, disputed the contention that she was acting only now in response to the GOP pressure. Hamos provided a series of letters and a timeline of contacts with the Obama administration on the issue and said she also met personally with top federal agency officials. Hamos has estimated the state’s anti-fraud measures could save closer to $1 million, saying she prefers to give a conservative estimate.

Hamos acknowledged it’s a “risk, a small risk” to move ahead with the anti-fraud approach without the federal government signing off, but said it needed to be done to protect the integrity of Illinois’ Medicaid program.
On Thursday, federal officials released a statement from a spokesperson with the Centers for Medicare & Medicaid Services within the U.S. Department of Health and Human Services.

“We requested additional information from Illinois regarding the nature of their program integrity concerns and we are reviewing this response,” the statement reads. “We are committed to giving Illinois and all states the ability to maintain the integrity of their Medicaid programs, while ensuring that beneficiaries continue to receive access to the care they need to live healthier lives.”

Hamos said she feared the federal process would have involved waiting and appealing and “then six months from now we would still be tearing our hair out and saying, ‘Where is the approval?’”

“We support the Affordable Care Act,” Hamos said. “We are in the minority of states right now that really want it to work. We’re all working very hard to make it work. So we don’t see any conflict here. That’s what I’m hoping that they will understand.”