Opinion

GUEST COLUMN, Dane Hicks, Kaninfo.com

Among the most ignored stories of Trump II is the administration’s confrontation of the stifling abuse of the federal Medicaid program – a story being buried by the mainstream media in hopes you’ll ignore this reality and obsess about Sydney Sweeney’s American Eagle Jeans commercial right up to the 2026 midterms.

It’s also set to be the round robin issue of the coming Kansas Legislative session, as Governor Laura Kelly takes one final shot to convince or cajole the Republican-dominated state legislature to allow 130,000 new and able-bodied Kansans a place on the state Medicaid rolls.

The governor’s thinking? What the heck; it’s only money.

The intricacies and the immensity of the federal Medicaid program are, like most line items of U.S. Government spending, hard for the average bear to fathom. Medicaid came out of the “I’m from the government and I’m here to help you” era of President Johnson’s Great Society, enacted back in 1965 alongside legislation that created Medicare. It initially focused on welfare recipients (those receiving cash assistance under programs like Aid to Families with Dependent Children), then began a continuing expansion that blossomed under “Obamacare” to balloon federal spending by half a trillion dollars (2014-2020) and drop new taxes on Americans to try to cover the deficit.

The Centers for Medicare & Medicaid Services (CMS) reported Medicaid improper payment rates of 15.6% in 2023, amounting to approximately $50 billion. “Improper payments” include fraudulent claims, clerical errors, insufficient documentation, and payments for ineligible services or individuals, not all of which are intentional fraud – some of it  just incompetence.

Fraud itself is a subset of improper payments but is notoriously difficult to quantify precisely because many fraudulent activities are never detected or prosecuted. The most common was to bilk Medicaid and the U.S. Taxpayers: Billing for services not provided; Upcoding (billing for more expensive services than delivered); Unnecessary services ordered to inflate claims; Kickbacks between providers and beneficiaries or other providers; Eligibility fraud (false income reporting or residency data); Pharmacy fraud, including overprescription or diversion of controlled substances. Scamming Medicaid has all been revealed for years by both Democrat and Republican administrations.

And then there’s waste. Duplicate tests due to lack of records integration. Hospital admissions that could have been outpatient care. Long-term care services billed without proper assessments. Administrative complexity across state-managed programs. Add in the multiple of Barack Obama’s golden goose HCA with its obnoxiously expensive bribe to states of more Medicaid dollars if they’d only buy into more centralized social health care, and you’ve got a cash cow that’s just too tempting to pass up for medical providers and those who know how to work the teats.

And working the current system has it’s own benefits. Through acquiring additional certifications, the Southeast Kansas Mental Health Center managed to expand its Medicaid revenue profile into “life changing money” as one of its board of trustees recently told the Anderson County Commission. That administrative move zoomed the agency’s budget exponentially to some $80 million and 400-odd employees in three years, and an executive director’s compensation package of more than $625,000 annually. The region serves six southeast Kansas counties – a population of around 63,000 – with the largest budget and director’s salary of all 26 mental health regions in the state.

The federal government allocated over $1.7 billion for Medicaid expansion grants and an estimated $8.5 billion earmarked for Certified Community Behavioral Medical Health Clinic payments between 2022 and 2032, according to the Amercan Journal of Managed Care. But a focus on waste, fraud and abuse in federal agencies by the Trump Administration means CCBHCs and other Medicaid funded program may face fiscal examinations that could impact future funding and expansion.

Politically embarrassed by leaks to the press, federal and state governments have invested heavily in trying to rectify this budget bleeding behemoth. Medicaid Fraud Control Units (MFCUs) jack up costs in every state investigating and prosecuting fraud and patient abuse within its own system. Obamacare was supposed to strengthen screening of providers at the same time it bulked up the system’s cash with new taxes. Still, incidents of fraud and the amounts of money wasted has grown by leaps and bounds. Whether unintentional neglect or out-and-out fradulent filing of claims, waste, fraud and abuse of the U.S. Medicaid system remains a systemic challenge amounting to billions of borrowed dollars, and a topic that’s been talked to death until the second election of Donald Trump.

Instead of educating the public about this theft, “doging” Medicaid is presented by mainstream media as Republicans on a quest to exterminate poor people. The income statement on Medicaid tells a different story.

The true story – one that would illustrate just how much money is stolen and wasted while some Americans who truly need the help sit on waiting lists for assistance –  is not being told. We have to wonder why.