EagleTribune.com, North Andover, MA

October 21, 2012

Editorial: Fear of ‘barriers’ leaves MassHealth open to fraud

The Eagle-Tribune

---- — Once again, a state program aimed at helping the less fortunate has been exposed as a fraud free-for-all.

MassHealth is the Bay State’s version of Medicaid. State Auditor Suzanne Bump released an audit of MassHealth that found the program is losing millions of dollars to fraud.

That should be a warning to the rest of the nation. The Affordable Care Act, better known as “Obamacare,” is expected to funnel millions of the nation’s citizens into their states’ Medicaid plans. The level of fraud found here could be magnified across the country.

Thousands of out-of-state residents could be taking advantage of the program to provide health care benefits to low- and moderate-income individuals living in Massachusetts, according to the report.

Bump’s audit found that MassHealth fails to verify the residency of benefits recipients. The audit also found that others may be receiving benefits while not meeting income qualifications, the State House News Service reported.

The failure to maintain eligibility standards could be costing the state millions. MassHealth is an enormous program serving 1.3 million enrollees — or about one in five Massachusetts residents. In fiscal year 2011, the program paid health care providers more than $12.2 billion, of which 35 percent came from state funds. The program’s costs are growing on average 8.7 percent annually, Bump’s audit found.

Bump’s office found MassHealth does not verify an applicant’s state residency, relying solely on self-declaration, the State House News Service reported. MassHealth only checks someone’s address when there are conflicts in an applicant’s information. The policy leaves MassHealth vulnerable to fraud, according to the auditor’s report.

Given MassHealth’s weak eligibility standards, fraud is inevitable.

In 2010, MassHealth spent approximately $6.5 million on services for 4,643 individuals who were later removed from the program because they were not Massachusetts residents, received benefits from another state, or state officials could not determine where the enrollees lived, the news service reported.

“I realize that MassHealth has a very difficult job to do to maintain access to folks that experience a lot of job and residency instability. At the same time you’ve got to weigh that against the finite number of public dollars that support this program,” Bump told the news service. “I urge MassHealth to find a better balance.”

For defenders of the status quo, there’s always good reason to do little. When it comes to stopping fraudulent use of state benefits, the concern is “barriers.”

Bump’s audit suggested that MassHealth officials should ask for driver’s licenses, utility bills or other proof of residence for applicants for benefits.

But according to Dr. Julian Harris, the state’s Medicaid director, such requirements might raise barriers for some of the state’s most vulnerable residents.

So the fear that someone, somewhere might be denied a ride on the benefits gravy train means the entire program must remain open and vulnerable to waste and fraud. That’s ridiculous.

Can’t show a driver’s license or a utility bill because you’re homeless and don’t drive? Fine, get a letter from the chief of police attesting that you live under a bridge or a note from the soup kitchen director saying you eat there every day. Just get something, anything, that proves you live in Massachusetts.

Is that too much to ask for the privilege of having your health care provided by the state’s taxpayers?

There’s already millions of dollars in fraud from the early stages of mandated health care in one medium-sized state. Wait until Obamacare rolls out nationwide and hundreds of billions get stuffed down the health-care pipeline. It is reasonable to expect that the level of fraud will be in the billions.