Let's say you are watching TV one night and you start to feel faint. You pass out. Your wife rushes you to the hospital. Doctors diagnose a brain tumor but expect a full recovery. Treatment takes six months, and you come away feeling fine. But broke. The medical bill comes to $100,000. You check with your health care insurance carrier. The company can cover 90 percent of the costs. Whew! All you have to do is fill out the proper forms and get them to the insurance company within 30 days.
You get the forms. You get busy. You put off filling them out. You finally submit them, but the insurance company finds errors and explains how to fix them. You get busy.
The hospital sends a bill for $100,000. You submit it to the insurance company. They say your proper paperwork never arrived, the time limit has expired, and you are now liable for the full amount.
You must declare bankruptcy. You lose your house. Your wife splits. But your brain is fine.
This combination of diddling and incompetence is exactly what transpires between the District of Columbia and the federal government when it comes to Medicaid reimbursements. It is a terribly complicated process, defined by reams of rules, but it boils down to this simple procedure: The federal government, by law and regulation, is required to reimburse D.C. for Medicaid expenses, but D.C. cannot submit the proper paperwork.
In the past decade, the District has had to write off $347 million in funds it failed to collect from Medicaid, according to a document generated by the chief financial officer. The District is facing a budget deficit of $460 million. Do the math: If the city had collected the Medicaid funds, it would be only $113 million in the red.
Now, I know that's a simplistic calculation, and if the city had had the $109 million it was supposed to have collected in fiscal 2008, it might have spent the funds. But the fact remains that year after year, for the past few decades, the District has left millions on the table by not filling out forms and filing them with the feds.
Everyone knows about this fiscal disgrace. Council members David Catania and Tommy Wells were not surprised this week when they were informed that D.C.'s social service agency has not been able to even apply for Medicaid reimbursement since 2009 -- and it still cannot -- because the paperwork and computer systems can't process the forms.
Catania said the dysfunctional systems "date back decades."
Four mayors and dozens of city council members have stood by and lost hundreds of millions to pure ineptitude. They see the numbers. They complain. They wag their fingers. The money stays gone.
Compare that with New York. The feds are suing the city for overbilling Medicaid. At least the city submitted bills and got the funds.
Why can't D.C. do the same?
Stay tuned for answers and solutions.
Harry Jaffe's column appears on Tuesday and Friday. He can be contacted at email@example.com.