WSJ: Two family planning providers serving low-income women say their operations will be at serious financial risk if state auditors stand firm on claims that they overbilled Medicaid by $3.5 million, largely for birth control drugs and devices.
Department of Health Services Inspector General Alan White defended his auditors’ choice of targets and their findings. “This administration, this agency has put a great deal of effort into improving program integrity,” White said. “And protecting the taxpayers of Wisconsin is their predominant responsibility.”
"Integrity." A Republican buzzword for “your next” for cuts, in this case the end of contraception for low-income women. The state has decided to change and interpret the rules differently for contraception, even though providers were never told or given the ability to itemize their services with the state. Here's the basics of Walker's scheme to supposedly "protect taxpayers:"
The auditors are challenging a reimbursement price for oral contraception that providers say the state itself set and is what their peers use. The claims concern the clinics’ use of Medicaid’s 340B drug-pricing program, in which pharmaceutical companies are required to provide discounted drugs to safety net providers. They say the state never asked them to track those costs individually, and instead told them to bill for each monthly pack of birth control pills the “usual and customary charge up to the maximum allowable fee,” which the state set at $26.02 in 2009 … the higher reimbursement rates help the clinics avoid losing money. The auditors faulted the providers for failing to bill Medicaid for the actual cost of each pack of oral contraception, plus a dispensing fee.Here's their sneaky way to go after contraception for low income women:
Office of Inspector General’s White argues that the rate does not apply to the 340B drug-pricing program — it was directed at “family planning clinics” — and so is irrelevant. But virtually all of the family planning clinics are enrolled in the 340B program.And it gets even more transparently obvious:
Jennifer Waloway, NEWCAP’s director of community health services said NEWCAP may have to close; “I don’t understand how they can expect anybody to be sustainable in a business when all you can charge is acquisition price,” Waloway said. “Nobody can run a business like that.”
The state is also claiming money on the grounds that the providers entered claims incorrectly. It states the providers did not note the invoice price for medications. But providers say the state’s own computerized claim-entry system does not include a way to enter the cost. Public policy director Nicole Safar said, “This is a very under-the-radar way to block access to birth control.”And as usual, Democrats were silent in their outrage, working behind the scenes I guess:
Two Democratic lawmakers, Rep. Chris Taylor of Madison and Sen. Dave Hansen of Green Bay, wrote the inspector general last week saying “there appears to be no legal basis” for the claims.If this had happened to the Republicans, we wouldn't be hearing the end of it.
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