Archive for Wednesday, September 13, 2006

Medicaid losses may grow by $80M

Federal audits put state in long-term dilemma

September 13, 2006


— State officials and the federal government are at war over tens of millions of dollars that buy health care services for poor and disabled Kansans.

So far, Kansas has lost $32.4 million in Medicaid funding and could lose upwards of $80 million more, officials said Tuesday.

The losses are attributable to federal audits of how Kansas spent funds under Medicaid's school-based health programs from Oct. 1, 1997, to Sept. 30, 2003.

State Sen. Jim Barone, D-Frontenac, said he feared the lost funds would result in Kansans not getting needed assistance.

"Somebody has to be shorted that $32 million; some Kansas citizen, someplace," Barone said during a meeting of the Legislative Budget Committee.

But Scott Brunner, director of the Kansas Medicaid assistance programs, said the state hoped to handle the problem without reducing services.

"We're trying to manage cash flow as best we can knowing that there are shortages coming down the road," Brunner said.

But he said legislators may be asked to replace the federal funds with state tax dollars when the next session starts in January.

Contested audits

The audits by the U.S. Health and Human Services Office of Inspector General have focused on Medicaid funds spent in school districts.

One audit claims that in some instances payments were made for services that weren't delivered.

Brunner denied the allegation.

"We have challenged this finding in total," he told lawmakers.

The HHS Office of Inspector General reviewed 300 claims from the Wichita, Kansas City and Salina school districts and said 217 claims were for services not rendered or services that didn't include the required prescriptions or referrals. Applying that unallowable cost to the entire amount of federal funds that Kansas receives under the program could result in a loss of $80 million, lawmakers said.

Monitoring continues

Brunner said Kansas is among many states facing audits as the federal government tries to tighten Medicaid expenditures.

Officials with the HHS Office of Inspector General declined to comment on the audits or respond to submitted questions from the Lawrence Journal-World.

"This is part of our workplan," Laura Bradbard, spokeswoman for the HHS Office of Inspector General, said of the audits.

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Kansas failed to follow federal guidelines in several areas, according to the audits.

The state has challenged some of the federal findings but accepted others. For example, the state wrongly advised school districts to claim Medicaid costs for 12 months instead of the nine-month school year.

The federal government drew down the state's share of Medicaid funding by $13.9 million in May, and will make another $18.5 million drawdown in November, Brunner said.

The reduction represents less than 3 percent of what the state receives annually for Medicaid from the federal government.

In all, there are at least five audits of Medicaid payments made by school districts. Kansas received approximately $135.2 million during the period considered by auditors.

Members of the legislative committee said it was difficult dealing with the federal government's rules. In some instances, federal officials found Kansas failed to implement practices that would have resulted in the expense of more federal dollars, they said.

"This is a complicated system, and it's hard to make it work correctly," said Rep. Melvin Neufeld, R-Ingalls, chairman of the House budget committee.

Brunner said he hoped the state could resolve all the audit recommendations and findings by the end of the year.


janeb 11 years, 5 months ago

If you ever worked for a Company that billed Medicaid you would know the scandals that go on with billing practices.
The last two companies I worked with commited blatent fraud in billing for services.
If the company is allowed to bill for 20 hours a week in case Management services they will bill for 20 even if only 10 were completed. The School District does the same thing as does Bert Nash. The problem is that people do not care enough to speak out when they see Services are not being fulfilled. Why would they is is not their money. Individual Audits happen 1 time per year unless a complaint is filed. During scheduled audits Companies prepare so the errors are not so clear. Private Physians are guilty of this too. Everyone has heard about unnessasary testing. Currently Medicaid is the best insurance going in the billing world; Doctors take advantage of this. Welfare fraud is not limited to someone claiming benefits to which they are not entitled; the larger fraud is at a much higher level. Anyone who has worked in a service oriented position knows it is true.

lori 11 years, 5 months ago

Actually, doctors often cringe when they see Medicaid as an insurance. The regulations are extensive, complex, and in some cases very different than other insurances. Reimbursement is minimal. Unnecessary testing? Hell, it's difficult to get Medicaid to pay for NECESSARY testing. In my experience, anyhow.

ASBESTOS 11 years, 5 months ago

Are the schools gonna come back and ask the legislature for more money because they "lost" all this medicaid money?

ASBESTOS 11 years, 5 months ago

"Salina school districts and said 217 claims were for services not rendered or services that didn't include the required prescriptions or referrals."

It was the large school districts that took our tax money and sued us with it! It is the large school districts that are the ones with the money p[roblems while their cities give HUGE tax abatements.

NOW we find they are using medicaid to partially "fund" the school services??? How much damn money is enough for these large school districts???

Sharon Roullins 11 years, 5 months ago

Why is it when one person or a group of people decide to steal, embezzle, commit fraud, innocent people usually end up suffering from their greedy, selfish, no good selves? We don't want our taxes raised but we are so quick to say cut programs. I receive Medicaid and believe me, it is no picnic. My choices are very limited and everyone is so quick to make a comment about it, including doctors, but don't ever get to the point in your life when you don't have your fancy-i-paid-way-too- much for health insurance turns you away. If you work for an agency you know is overbilling Medicaid or committing fraud in any other way, BLOW THE WHISTLE ON THOSE CROOKS!

KSAGMFCU 11 years, 5 months ago

To janeb (and any others who have evidence that any Medicaid provider has submitted false claims to the Kansas Medicaid program):

Please contact the Medicaid Fraud Control Unit in the office of Kansas Attorney General Phill Kline at 785-368-6220 or 120 SW 10th Topeka, Kansas 66612.

OfficeGirl 11 years, 5 months ago

Take the $ out of the salaries of those who were supposed to do it right in the first place. Let the Legislators take pay cuts, etc. Why should taxpayers or the very ones who need the help have to shoulder the burden of this 'mistake'? How did this mistake happen anyway? Do we have professionals or amateurs running things? Wake up folks and do the job for which you are being well paid to do.

janeb 11 years, 5 months ago

Those who think Whistle Blowers will help better think again. They DO NOT and WILL NOT come into Kansas. Now let the ex law clerk tell you why since she is so quick to BLOW SMOKE up you know where and act like she knows. I have turned in an Employer. My post was based on actual experience. I spoke Directly with Earl Baxter and followed every one of his directives on the situation. ( in case you don't know who he is, he is the head investigator for fraud at the AG office.) This is what I find so comical about some posters on the forum. You have never experienced these things but you think if you look up a web site you know what the deal is.

lawrence_citizen 11 years, 5 months ago

If you worked for a company that bills Medicare-Medicaid, you would also know how utterly confusing their system really is. I'm not saying there isn't blatent fraud here, but there are also honest mistakes because there is no help from them in trying to understand their system. If you call for help, they don't give you any. They say "submit the forms and we will review them." Then if it is wrong, they sic the attorneys on you.

janeb 11 years, 5 months ago

What I gathered proof on was massive (Medicaid )fraudulent billing for services not rendered. Vison Card fraud and TANF and blatent disregard for the needs of Clients. The Agency is still open.

joshs_mom 11 years, 5 months ago

Part of the problem is that SRS in many cases does not go after consumers who have intentionally broke medical program rules by not reporting changes in their income or living situation. Consumers get a list of changes they have to report within 10 days if they have a change in their income, etc.

For TANF or Food stamps the agency will make the consumer pay the amount they received (overpayment) back.

Rarely is a consumer required to pay back their medical overpayment.

More fraud investigators are needed, I think especially for medical programs

janeb 11 years, 5 months ago

There need to be stiffer penalties. A Agency/Facility that commits fraud should not only be sanctioned and have to repay but should also lose billing priveledges for a period of time. Just as individuals who commit fraud are penalized in series. If the "errors" continue after that they should be barred from State funding of any kind. This will eliminate the " we get so confused by the paperwork" garbage the agencies spew. For the record the State trains people how to do these forms and it is the agency's responsiblity to have their Billing Staff trained. No one makes that many mistakes and the State allows billings with errors to be resubmitted.

KS 11 years, 5 months ago

janeb - I am on your skateboard. I too, have had first hand experience with Medicaid providers. You tell SRS, you tell legislators, you tell KDOA and it goes in one ear and out the other. The State of Kansas is in the trouble they are because they don't have the "you know what" to go after those who fraud the system. They don't want the black eye. Well, they are getting one now.

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