A pair of legislative proposals could help cut some of the state’s Medicaid costs by helping to reduce fraud. The bills from state Representative John Nygren (R-Marinette) would allow health officials to investigate the financial records of Medicaid enrollees and determine if someone also has private insurance coverage.
Nygren says the bills will assure applicants meet the eligibility standards that are in state statutes, reducing the possibility someone can get away with lying in order to obtain state benefits.
With the state facing a multi-million dollar deficit in its Medicaid program, the Marinette Republican says any effort to cut costs is welcome. He estimates the changes would save the state over $6 million a year.
The first bill allows the state to access the bank records of those applying for Medicaid. Nygren says that information is currently self-reported, leaving the system wide open to fraud. He says those “coming to their friends and neighbors to ask for help” should be checked out to make sure they actually qualify for the program.
The second bill would require insurers to report who they are covering, allowing the Department of Health Services to determine if Medicaid is being billed for something private insurance should be covering. Nygren says Medicaid is the “payer of last resort” and individuals with private insurance should not be allowed to have taxpayers foot the bill. While he believes many cases where Medicaid is billed may be a mistake, Nygren says many people may be failing to report private insurance coverage to avoid higher co-pays or deductibles.
Nygren says he expects the bills to move quickly during the spring legislative session, given the interest from lawmakers in addressing the state’s Medicaid debt.
AUDIO: Andrew Beckett reports (1:08)