States need right tack on Medicaid refunds

State-by-state attempts to recover Medicaid money from physicians are reminiscent of similarly high-handed tactics from Medicare.

Editorial. March 12, 2001.

Our recent coverage of state-by-state efforts to recoup Medicaid money from physicians -- "Doctors irked by state's tactics on Medicaid fraud" (AMNews, Feb. 19) -- was somewhat reminiscent of our reports about Medicare over the years -- not a good sign.

Recovering taxpayer money that should not have been spent is a worthy motivation, but too often it has led to high-handed and overly aggressive tactics targeting doctors. The result is that many honest physicians are hassled and some may be intimidated into paying back money they should not owe. That's no more acceptable when done by the states than it is at the federal level.

As we reported, about a half-dozen state Medicaid programs already have or soon will sign on with computer contractors to retrospectively review payments, and it's reasonable to expect the practice to spread. Despite the high-tech twist, at least a couple of these early states seem to be exhibiting some all-too-human bureaucratic failings.

Physicians in Washington and Kentucky have been most outspoken about the reviews, and with good reason. For example, Washington physicians received repayment demands without accompanying documentation to establish what Medicaid policy was at the time a payment was made -- a problem because policies change. Meanwhile, in Kentucky, doctors were frustrated by a system unable to handle their appeals of refund demands. [...]