After the Ohio General Assembly last month passed measures aimed at limiting fraud in the state’s Medicaid program, a panel of economists is split on their potential effectiveness.

Senate Bill 315 is awaiting Gov. Mike DeWine’s signature. Among other ways it seeks to reduce fraud it:

  • Requires the Ohio Department of Medicaid to suspend payments if the state attorney general or auditor submit a credible allegation of fraud

  • Enhances criminal penalties for fraud

  • Requires electronic verification of home-care visits if the provider doesn’t live in the home

  • Provides whistleblower protections

When Scioto Analysis surveyed 13 economists on whether the reforms would be beneficial, they mostly seemed to say that it’s hard to tell.

They were first asked whether they agreed that “Medicaid fraud prevention programs that increase penalties and require additional verification and inspections will create fiscal savings that outweigh the administrative costs of running them.”

Five agreed, four disagreed, two were uncertain and one had no opinion.

Michael Jones of the University of Cincinnati said he believed the savings would outweigh the costs.

“A low-cost verification system that confirms identity and eligibility at the moment that services are provided should produce a positive (return on investment) for Ohio,” he wrote in the comment section of the survey. “Ohio should be implementing electronic visit verification for nearly every service that is reimbursed.”

But Curtis Reynolds of Kent State University said it was hard to see how the increased administrative cost would pay for itself.

“This is always the challenge: more verification/inspections are costly and I do not think that there will be much fiscal savings,” he wrote. “Medicaid fraud does exist but the estimates are that it is not a large percentage of total spending.”

The economists were also asked whether they agreed that “Medicaid fraud prevention programs that increase penalties and require additional verification and inspections will reduce access for vulnerable populations like people with disabilities.”

This time they divided evenly. Four agreed, four disagreed and five were uncertain.

“Vulnerable people are likely to get snared by the fraud prevention program which may penalize people who Medicaid is supposed to help,” wrote Charles Kroncke of Mount St. Joseph University, who agreed the new regs would cut some access for the disabled.

But Jonathan Andreas of Bluffton University said the new rules could benefit the disabled in the long run.

“It will undoubtedly reduce access in the short run because of inevitable false positives which reduce necessary care,” he wrote. “But in the long run, IF it increases the efficiency of Medicaid, it could increase care because of helping channel scarce dollars to the patients who really need them rather than to fraudsters.”

The panelists were also divided on the overall economic effect of the new rules, should they become law.

They were asked if they agreed that “Medicaid fraud prevention programs that increase penalties and require additional verification and inspections will generate a greater economic return than expanding benefits for recipients.”

Two agreed, three disagreed, five said they were uncertain and one had no opinion.

Andy Welki of John Carroll University said the new rules could create better public sentiment about Medicaid, which itself could produce a benefit.

“Confidence in a well run system promotes greater support,” he wrote.

But David Brasington of the University of Cincinnati said it’s too early to tell whether the benefits will outweigh the costs.

“We won’t know the extent of fraud currently committed or prevented until such measures are enacted,” he wrote. “Expanding benefits for current recipients would increase costs, fraud, and access to care.”

This story is republished from the Ohio Capital Journal under a Creative Commons license. View the original article.