Why require a waiver for something that makes sense?

Atty. Gen. Bill McCollum and the Secretary of the Agency for Health Care Administration, Tom Arnold, held a press conference this week to announce that something might happen soon.

They said the federal government may be about to give Florida official permission to let the Attorney General's Medicaid Fraud Control Unit help AHCA look for signs of fraud before claims get paid. Currently the AG's investigators and prosecutors can't get involved until after AHCA finds the fraud.

McCollum and Arnold said they have an understanding from federal health officials that they'll get the waiver -- a verbal agreement, but  nothing yet in writing. In other words, they held a news conference to announce that there may soon be actual news.

But the weirdest thing was that they had to ask permission in the first place. Under federal rules, only the state's Medicaid agency -- in Florida, that's AHCA -- is allowed to see the claims data. The AG's Medicaid Fraud Control Unit prosecutes cases after AHCA's staff or contractors find a pattern of fraud or abuse.

Given that fraud has been estimated by state auditors to account for more than $3 billion of Florida's annual Medicaid budget, it seems wise to employ more crime-fighters to make cases and nail perps before the money disappears.

So why did the Centers for Medicare and Medicaid Services force Florida to waste a year seeking permission to do this? Imagine the amount of paperwork and wasted time involved if other states want to do this, too.

Instead of granting permission one state at a time -- a process that could take years -- why doesn't CMS just grant all the states permission to let Attorneys General help police Medicaid? They're the ones who have the expertise.

This appears to be a case of over-regulation. If it takes an act of Congress to fix it, I hope some member will lead the way.
 
--Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.