A Georgia fund set up to aid crime victims could save millions of dollars each year by not paying the full “sticker price” to hospitals and other health providers for services, state auditors say.
The same auditors also questioned whether the Crime Victims Compensation Program, which aids thousands of Georgians each year, is getting all the probation fee money it should to fund the effort.
Agency officials say making some of the changes recommended by auditors would mean changing state law and pitting themselves against powerful health care interests in a General Assembly battle they would have a tough time winning.
“The lobbying effort we would have to undertake is not feasible,” said Steven Hatfield, deputy director of the Criminal Justice Coordinating Council, which administers the program. “You’re going to have all the hospital associations, all medical associations.”
Health care groups have contributed more than $300,000 to the campaigns of state lawmakers and party political action committees this year, through late October, according to an Atlanta Journal-Constitution review. The groups have teams of veteran lobbyists who have strong influence on health care policy in Georgia.
Auditors began looking at the fund in part because of its dependence on probation fees and because of problems in collecting those fees.
The program took in $13.5 million in fines and fees in 2016, down about 16 percent from a few years ago. Benefits paid out to crime victims fell about 8 percent from the previous year, auditors found.
Established in 1988, the program offers financial help to victims of violent crimes. It is the payer of last resort, with applicants eligible to receive up to $25,000 to help with medical and dental care, mental health counseling, economic support, crime scene cleanup, and funeral expenses when the costs are not covered by a third-party payer.
Much of the money goes toward medical bills. The program caps those medical payments at $15,000 per claim.
The audit said the program processes about 4,000 claims from victims a year.
Auditors said the state could save big money on the $15 million in medical claims each year if the agency used lower rates similar to those paid by Medicaid and Medicare, the government health care programs for the poor, disabled and elderly.
“The program (currently) pays the full charge listed on each medical bill, even though these ‘sticker prices’ are significantly higher than the amounts typically paid by patients or providers,” the audit said. “Numerous reports have stated that listed charges are unrelated to the amounts paid by insurers, either private or public.”
Auditors said the state’s Board of Worker’s Compensation, for instance, uses a fee schedule based on what Medicare pays doctors, hospitals and other health care providers.
They said paying the lower rates would not affect the care given to crime victims and would allow the program to pay a greater portion of a victim’s medical bill. They also recommended that lawmakers amend state law to force health care providers to accept the amount that they get as full payment for a crime victim’s medical bills.
According to the audit, program officials responded that the agency doesn’t have “the ability, knowledge, staffing or statutory authority to require multiple hospitals and providers throughout the state and the country to accept certain negotiated rates.”
Agency officials also said it could prove to be a financial hardship on rural hospitals and providers, and that they didn’t “have the proper staff, time or funding to overcome lobbying efforts in opposition to a fee schedule and acceptance of payments as payments in full.”
That is important because paying Medicaid or Medicare rates would mean far less money for hospitals, and they would fight any effort to reduce payments.
Jimmy Lewis, the CEO of Hometown Health, a coalition of rural hospitals, said paying hospitals and doctors Medicaid rates would result in about a 50 percent cut in what they receive for services.
“That would be a real killer for rural hospitals that are struggling,” Lewis said.
Selling such a move would be extremely difficult. Since 2013, at least five small-town hospitals in Georgia have closed, and only this year the General Assembly approved $180 million in state tax credits to donors who contribute to small-town medical centers in hopes of stabilizing the situation.
A move that would mean less money for rural hospitals would likely be a legislative nonstarter.
Auditors also found that the program may not be getting all the crime victim fees that it should from people on probation. The fund’s primary revenue source is a $9 monthly fee assessed to all supervised Georgia probationers.
They said the program should compile collection data in a format that makes it easy to identify which probation providers are not making proper payments, and that it should contact companies that are failing to remit the fees or remitting inconsistent amounts.
The agency said it is working to address the problems, but it noted that a 2013 effort to improve fee and data collection was met with “substantial resistance.”
Hatfield said: “The problem is within our statute, we are to receive the funds, but we have no enforcement authority. We don’t have the tools and ability to say we are getting everything we are supposed to be getting.”
But he added, “We’re getting almost all of it.”
Department of Community Supervision officials said they intend to develop rules that would include sanctions against probation providers that aren’t properly remitting the fees, the audit said.