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Misplaced Priorities in Medicaid Dispensation

by Medindia Content Team on February 13, 2006 at 4:53 PM
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Misplaced Priorities in Medicaid Dispensation

Olympia: Its Audit time and things are coming under the microscope. Coughing up for health care for the needy, cost the exchequer a whopping sum and while they struggled to make the amount, taxpayers at Washington were paying up for frivolous operations like a sex change, penile implants and breast lift up jobs, to suit people's fancy.

Auditor Brian Sonntag, found many fishy areas in the Medicaid expenses with thousands of dubious expenditures in 2004 fiscal year. One account in particular threw him off balance - Where Medicaid had forked out a whopping $9,549.92 for a sex change surgery. It is extremely disconcerting when the needy, like the old people, do not get medications while on the other hand, and tax money is spent on frill surgeries, which is certainly not a do or die situation.

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Officials at the Department of Social and Health Services have disagreed with many of the report accusations. Sontag, however holds the stance that there is enough evidence in the report to suggest that tens of millions of dollars have been spent on questionable procedures.

Drug Potter, The State Medicaid Director, is extremely upset with Sonntag's conclusion and said "The debate would be whether or not they were medically necessary, and medical necessity is a term that is, as we speak, is undergoing revision. ... There are many things that we have traditionally paid for that were deemed medically necessary that we are calling into question on a more frequent basis."
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According to Drug Potter, a sex-change operation, diagnosed as Gender dysphoria, is a psychological condition suffered by the patient, and the surgery is an obvious corrective measure. Therefore it can rightfully come under the purview of Medicaid.

Now, Medicaid stipulates patients to experiment with less costly treatment methods the before taking the final step of a sex change operation. According to Potter, the scrutiny does not indicate non-reimbursement for such surgeries except that the conditions for payment have become stringent.

Sonntag, however sticks to the report findings saying "Certainly there can be medical reasons for breast augmentation, a cancer surgery for instance," Sonntag said. "So we were very careful to look at those, and then look at them again, to make sure that these were not in that category. These kinds of procedures would be cosmetic and we identified those specifically," We don't want to be calling attention to procedures that certainly would be allowable, so these are outside of that."

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