Archive for Friday, December 19, 2008

Kansas Medicaid audit finds suspicious claims

About $10M involved in payments to noneligible recipients

December 19, 2008


— 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.”


KS 9 years, 3 months ago

Why does this come as a surprise? SRS has been handing out money right and left to the Independent Living Centers for years with no controls or oversight. Why do people move to Kansas? It certainly is not the warm beaches and sunshine. Dah? How many times do they need to be screwed to wake up. It is only going to get worse with BO at the helm.

Thinking_Out_Loud 9 years, 3 months ago

Hey, KS, read the report Less than one-half of one percent of spending was labelled "suspicious." That's hardly "handing out money right and left." And SRS doesn't adminster the program anymore.

lawthing 9 years, 3 months ago

$941 for a Cesarean section on an 8-year-old boy.......................................Now that had to hurt!

Leslie Swearingen 9 years, 3 months ago

I have a medicaid card which I use and am very grateful for. Please do not throw out the baby with the bathwater. Every dollar used for fraudulent purposes is a dollar taken away from someone who is sick and needs it. The medicaid system needs to be closely monitored and those who violate the rules punished. But, we also need to ask why so many people are dependent upon this. No, it is not because they are lazy and greedy. Two million jobs were lost last year, what are those people going to do? Health Care Access needs more space. Do not ask for whom the bells tolls, pal, answer the door.

lucky7brand 9 years, 3 months ago

I agree with defender. TOL wants to break $13 million down into 1/2 of 1/4 of 1/3%. who cares what the percent is. It is fraud and the Dr's or employees of the state of the medicaid program who are purposely frauding the medicaid system should be punished. If it were a person on medicaid frauding the system they would go to prison and pay fines.

kusp8 9 years, 3 months ago

I hope the baby from the 8-year old is doing okay! ;)

KS 9 years, 3 months ago

Thinking_Out_Loud - You are absolutely right about SRS NOT administering the program anymore, but they have tremendous influence over the ILC's which are doing the day the day stuff and they don't watch over it. The Kansas Medicaid Authority isn't much better. Take the control of the gatekeeper task away from the ILC's and a bundle would be saved. $10 million on people that don't qualify? That's a bunch. That's what I call handing out money. I'd be happy to take any or all of that minimal waste off their hands. Too many people on the programs that should not be and then when the State runs out of money, those truly in need get put on a waiting list. Tell me that's right? Hardly what I would call minimal? Don't care what Andy Allison says.

Thinking_Out_Loud 9 years, 3 months ago

lucky7 wrote "TOL wants to break $13 million down into 1/2 of 1/4 of 1/3%. who cares what the percent is. It is fraud and the Dr's or employees of the state of the medicaid program who are purposely frauding the medicaid system should be punished. If it were a person on medicaid frauding the system they would go to prison and pay fines."First, an exceptionally well-done exaggeration and parody of my post. Congrats--that must be a gratifying accomplishment! Second, no one said that those committing fraud should be given a pass. I only pointed out that the $13M is not evidence of rampant fraud or of uncontrolled spending. Should systems be placed that will find and deny payment of those $10M made to persons who don't qualify? Absolutely--but let's be smart about it. Implementing systems that will cost us $4.5M mean it won't be worth it. If it costs Kansas a quarter million dollars to find and deny the $600K in upcoding, it becomes a money-losing proposition. It's easy to become incensed with righteous indignation, but as Cleopatra pointed out, let's not throw out this baby with its bathwater.

Christine Anderson 9 years, 3 months ago

I find I agree with points made by Cleo and by the other posters who are outraged by fraud.Yes, any amount of fraud is unacceptable! At the same time, there are many Kansas who truly need Medicaid, and who do not abuse the system.If only we as a state had a fool-proof way to make sure that the gulity were punished, and not those who lawfully use the Medicaid program.

reality 9 years, 3 months ago

I agree that there are people that need and benefit from the medical card. BUT, there are people who PLAN ...hear me...PLAN TO HAVE ANOTHER BABY, and expect the state to pay for it. The state is already paying for their other two boys' daycare, and then the parents PLAN another one... Then Medicaid paid for, COUNT THEM, 4 sonograms because they were unable to tell for sure the sex of the baby. I'm sorry, I pay a little over $360.00 / month for my BCBS policy, and when my Dr. couldn't tell for sure what the sex of my baby was, the my Dr. said SORRY...BCBS won't pay for another one unless there is a medical condition with either you or the baby! These are problems! I'm sorry, but I strongly feel like if you are going to get a medical card, you better be free from tobacco use! If you can afford a pack of smokes (or more) every day, maybe you should redirect your funds! I also think that these people that have kids, and continue to have kids don't ever have to be responsible for them. Another case in point...a child my child attended school with gets FREE lunches, SRS paid daycare, a medical card...BUT his mom can afford to have a B-Day party at the T-Rex at Legends mall, according to mom...a $450.00 party! Or how about the women that can afford french tip fake nails, and name brand purses....for a hard working person, it is really hard to swallow when I do without, and my child definately doesn't get $450.00 parties, because INSURANCE is in our buget, and nails, purses, and more kids, etc... well...those things we just do without because school lunches, insurance, and daycare have to be paid! I think there should be a limit of help, and after a person continues to have kids the only thing Medicaid should pay for is to have her tubes tied so WE don't have to continue to pay for more kids! Don't get me wrong, we shouldn't have to limit the size of peoples families, but at what point does the government say ENOUGH...that is why there is so many people in debt...because they don't know when to say ENOUGH.

lucky7brand 9 years, 3 months ago

TOL thanks for the compliment and your desire to comment on my "exaggeration". And what the hell "rampant fraud"? How bought this. Someone scammed you out of 1/2 of 1/4 of 1% of your pay? Cool huh? But you report it to the police and they spend time and money on your case to find the fraud. It takes money to pay all these people to work on your case. And then if they find the person, then in takes DA's, judges, testimonies, pay for supeonas, and for all these people involved. For your, let's say $500. And hundreds or thousands of dollars to pay the people to work on your case. That comes out of tax payers money either way.

lucky7brand 9 years, 3 months ago

Also my perception of "don't throw out the baby with the bathwater" was to mean not to judge or punish all of those who are on medicaid just because of those on medicaid who do fraud.

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