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Medicaid Inspector General issues two new reports

Release Date: Nov 15, 2019

TOPEKA – (November 15, 2019) – Kansas Medicaid Inspector General Sarah Fertig today released two new reports ahead of Monday’s scheduled meeting of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight.

The first report is a performance audit report examining whether the Kansas Department of Health and Environment (KDHE) has efficient systems in place to timely and appropriately discontinue Medicaid eligibility when a beneficiary enters a state prison. The inspector general reviewed all admissions to the Topeka Correctional Facility during fiscal year 2019 and examined how admissions of Medicaid beneficiaries were handled. That review found:

  • In 176 of 230 cases in which a person admitted to prison was receiving Medicaid benefits, Medicaid eligibility was timely discontinued in accordance with KDHE policies.
  • In 54 of the 230 cases, eligibility was discontinued late or not at all. The report noted that roughly half of those instances occurred in fall 2018, when a delay in the processing of some prison admissions from July through September of that year resulted in erroneous eligibility. The remaining instances involved discrete processing issues the inspector general grouped into eight categories.

The performance audit report contains six recommendations for KDHE to resolve the issues identified, as well as KDHE’s responses to those recommendations.

The second report, delivered at the committee’s request, details the state's current resources for investigating cases of suspected Medicaid eligibility fraud. The report describes relevant state and federal laws, policies, and resources, as well as practical considerations that may affect how an individual case of potential Medicaid eligibility fraud is handled. Notably, the report found:

  • Neither KDHE’s Division of Health Care Finance, nor its predecessor agency, the Kansas Health Policy Authority, has ever had dedicated investigators on staff to investigate Medicaid eligibility issues, and KDHE lost the ability to use the Department of Children and Families’ investigative resources following the January 1, 2016, effective date of Executive Reorganization Order No. 43, which transferred all Medicaid eligibility duties to KDHE.
  • A host of factors affect how each case of potential Medicaid eligibility fraud is handled, including whether there is sufficient evidence for a criminal prosecution and whether efforts to collect overpayments are feasible given the circumstances of the case.

The second report is intended for informational purposes only, and does not include any recommendations for policy change because the Office of Medicaid Inspector General must remain neutral on questions of public policy.

Both reports were submitted to Kansas Attorney General Derek Schmidt, Secretary of Health and Environment Lee Norman, and the members of the Bob Bethell Committee.

Copies of the reports are available at www.ag.ks.gov/medicaid-ig.

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