Topeka An audit of Medicaid expenditures in Kansas found nearly $13 million in “suspicious claims” in one year, including one for $941 for a Cesarean section on an 8-year-old boy.
The report released Friday by the Legislative Division of Post Audit covered the 2006 federal fiscal year from Oct. 1, 2005, to Sept. 30, 2006.
The Kansas Medicaid program, which is a combination of federal and state tax dollars that provide health care to low-income Kansans, paid more than $2 billion during the period that was analyzed.
Of those questionable claims, auditors said about $10 million appeared to be paid for services for people who were earning too much money to be eligible for Medicaid.
The audit also found some questionable amounts paid to doctors for a higher level of service than was actually provided, and some clients who received prescriptions from five or more doctors, which could indicate potential abuse.
The audit found some problems in dental claims, including 31 instances where a client received 20 or more dental procedures in a single day.
The Kansas Health Policy Authority, which took over administration of the Medicaid program in July 2006, said it agreed with many of the audit’s recommendations aimed at better accuracy on claims.
But Andy Allison, state Medicaid director, noted that the audit’s findings of $13 million in suspicious claims was a small fraction of the more than $2 billion in expenditures.
“We are pleased that the audit revealed no systemic problems warranting significant and immediate action, and welcome the recommendations to help improve payment accuracy,” he said in an official response.
He said KHPA did look at a some of the suspicious claims identified by the audit and found that some of those did end up being in compliance with eligibility rules.
In the situation of a provider being paid for a boy receiving a Cesarean section, the audit said KHPA officials said the claim “was caught by four different system controls but a data entry clerk improperly overrode each of these controls. Officials told us the clerk has been counseled about these actions.”