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MEDICAID State leader orders review of program



Published: Fri, April 15, 2005 @ 12:00 a.m.



The agency did a similar study of the child support system a few years ago.

COLUMBUS (AP) -- Ohio's welfare director has ordered a review of how Medicaid is managed while state lawmakers debate ways to control its spiraling costs and prepare to create a new agency to consolidate its scattered programs.

Barbara Riley, director of the Department of Job and Family Services, has ordered a 90-day review of the more than $10 billion state portion of the state-federal insurance program for the poor and disabled. The review was spurred by and will build on recent outside scrutiny, Riley said.

"We have been busy resolving some of the very specific things that were raised, but I'm very interested in looking across the board," Riley said.

The team will examine all practices and recommend changes. The agency did a similar study of the state child support system a few years ago.

Budget crunch

The next two-year state budget that passed the House this week and heads to the Senate targets Medicaid spending -- eliminating some coverage for adults, reducing payments to hospitals and requiring all recipients to shift into managed care.

While Family Services administers the program, the budget calls for consolidating elements by 2008 in the departments of Aging, Health, Mental Health and Mental Retardation.

Among the outside studies that have focused on ways Medicaid loses money:

UThe Ohio Commission to Reform Medicaid, which recommended the managed care switch, also called for using large contracts to obtain volume discounts on medicines and supplies and other changes that the group said could save about $1.3 billion.

UA consultant's report for the commission found more than $600 million in unusual pharmacy payments in 2003, such as nine or more doctors writing prescriptions for a single nursing home resident.

UOhio Inspector General Tom Charles said the program failed to collect millions of dollars in overpayments for incorrect or fraudulent bills from doctors and hospitals.

UThe Scripps Gerontology Center at Miami University in Oxford found that 3,200 of the 73,900 nursing home residents on Medicaid, or 4 percent, don't meet the program's medical standards.




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