With the possibility that laggardly South Dakota may finally expand Medicaid under the Affordable Care Act, let’s take a moment to consider Medicaid fraud. The people South Dakota catches ripping of Medicaid are usually not patients but providers like Dr. Annette Bosworth and counselor Shawn Nills.
The Affordable Care Act has numerous provisions to combat Medicaid fraud. I can’t tie this money directly to the ACA, but the feds did provide the South Dakota Attorney General with about $230,000 in FY2015 to tackle Medicaid fraud. According to the performance measures in the FY2017 budget proposal (under Attorney General—Legal Services, p. 29-2), in FY2015, the Attorney General opened 41 Medicaid fraud cases, closed 23, and has pending 59. The AG secured one felony conviction and one misdemeanor conviction and recovered $529,000. That’s a 2.3-to-1 return on the investment of those enforcement dollars (although John Hult notes that other departments invest resources in those Medicaid fraud investigations).
That ROI probably depends on unique aspects of prosecuting Medicaid fraud, but when the return on investing additional dollars in the IRS to pursue tax fraud is 6 to 1. And similar to finding the big money in Medicaid fraud among the providers, the IRS gets better return on enforcement dollars by pursuing wealthy cheaters.
The AG had a better year in FY2014… if we can call finding more fraud “better.” He turned a $296,000 Medicaid fraud grant into two felony convictions, seven misdemeanor convictions, and $3.56 million in recovered cash. That’s a 12-to-1 return on investment! Well done, Mr. Attorney General!
But notice that that $3.56 million in fraud was out of $785 million in total Medicaid. So documented, prosecuted fraud in South Dakota’s Medicaid program made up just 0.45% of expenditures.
Hmm… would anyone like to compare that fraud rate to the millions lost to monkeyshines in South Dakota’s EB-5 investment program?
When confronted with the specter of seven shotgun deaths linked to corruption in his office South Dakota Governor Denny Daugaard basically said, “s— happens.” Is that what you want from the executive running your health care plan?
If wingnuts actually lose next November’s elections,will they have enough time to change the law so their party officials can’t be investigated for crimes-kinda like what Wisconsin wingnuts did recently?
Cory,I’d love to give you the job of investigating all aspects of EB-5 if only I could persuade wingnuts to hand over ALL records and documents w/o redacting any.
Medicaid fraud is as nonpertinent an issue as voter fraud. Both are dog whistle attempts to instill fear in the Republican base; not a courageous group by any definition.
$600,000,000 is the number i understand EB5 has churned for joop&jeff,inc. and somebody keeps saying $120,000,000 (which i think is way low) is what the fraud constitutes, so you are the math whiz, cory!!
speaking of fraud, does anyone see a link between daugaard’s political delay of medicaid expansion to 55,000 southdakotans and his related, newly formulated hostage attempt at linking medicaid expansion with extortion from the federal government for more money from IHS–to the dilemma RST is experiencing with the emergency room crisis and Avera’s offer to aberdeen IHS to help??