Punish Medicaid Provider Cheats

Fraud is a crime. Most Americans still live by the rule that a person or company is innocent until proven guilty. But federal officials seem to believe that if a really good accusation can be made, it is time to get out the rope and tie a noose – financially speaking.

That could cost West Virginia millions of dollars in Medicaid funding we need to provide health care for low-income and disabled people.

State legislators have been told Washington may withhold the money because the state has not complied with a 2011 federal directive. It stipulated that states must stop making Medicaid payments to health care providers if credible fraud allegations have been made against them.

Alva Page, a lawyer for the state Medicaid program, told legislators his agency and legislative auditors interpret the federal law differently. In other words, Page is saying the state may not lose the money.

Let’s hope not. Still, lawmakers should be concerned about the issue.

They have been told by legislative auditors that at least $17.9 million – and perhaps as much as $211 million – was paid to health care providers whose cases were reported to the state Medicaid Fraud Unit.

Apparently, the legislative auditors believe such reporting would trigger withholding of federal funds under the Obamacare law.

Obviously, an allegation is nothing more than a claim someone has done something wrong. No one ought to be penalized for that.

But a larger issue – one in which many federal agencies bear guilt – is involved. It is that often, those believed to have defrauded state and federal governments are not prosecuted. Sometimes their contracts are cut off. Often, not even that much is done to punish them.

Legislators should ask what happens after allegations of fraud are made. If strong evidence of criminal behavior is found, are the offenders charged and prosecuted? If not, why not?

And if allegations are determined to be groundless, do records on the providers reflect that?

Federal officials should not withhold Medicaid money solely because of allegations. On the other hand, state officials should not let criminals escape prosecution. Legislators should pursue the issue to ensure the latter is not occurring.