Proposal gives state access to Medicaid patient records

Posted: Friday, July 01, 2005

In an effort to curb misuse of the Medicaid system, the state has proposed new regulations that would give it access to Medicaid patients' medical records.

The proposed change by the state Department of Health and Social Services would strengthen the state's ability to use the Medicaid Lock-In program to curb unnecessary doctor visits. The program restricts a Medicaid recipient's choice of health care providers if the state determines they have improperly or excessively used medical services.

The restriction is limited to fewer than 12 months.

Just over 100 people are enrolled in the lock-in program, but the state wants to increase the number, according to Doug Jones, manager of the Financial Services & Recovery Unit within the state Division of Health Care Services.

Jones said those who are put in the program make frequent and often unnecessary trips to the doctor or are receiving large amounts of prescription medications that are not all needed.

Individuals receiving Medicaid and suspected of overusing medical services are given a hearing by the Division of Health Care Services. If placed in the lock-in program, they are allowed only to receive care from doctors and pharmacists chosen by the state and categorized as "lock-in providers" or "primary care physicians."

Sandy Ahlin, a state medical assistant administrator with the Division of Health Care Services, said placing Medicaid patients with primary care physicians would provide a continuity of care that would save money.

"If a beneficiary is put with a primary care doctor, the doctor might identify duplicative services," she said.

Jones said it is unclear how much the proposed regulations would save Medicaid recipients.

But he said the program is more than just saving money.

"It makes sure people are getting the appropriate care too," he said. "A lot of people often go to urgent care centers and to another to the emergency room and what they really need is to get a relationship with a primary care physician."

Representatives of the senior citizen advocacy group AARP Alaska said they support the change.

AARP advocacy director Pat Luby said the state should have access to information that points to misuse of the Medicaid system. Luby said he believes many seniors would support giving up some privacy to free up more Medicaid resources. If savings are realized through enforcement, though, Luby said the money should be put back into the system.

"Fraud and abuse in Medicaid can be millions," he said.

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