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Archive for Sunday, December 21, 2008

Health official: Audit didn’t show fraud in state Medicaid program

December 21, 2008

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— A leading health official Saturday criticized a state audit of the Kansas Medicaid program, saying the report incorrectly insinuated widespread fraud.

Marcia Nielsen, executive director of the Kansas Health Policy Authority, said the report by the Legislative Division of Post Audit, and media reports alleged fraudulent activity. She said that was “not supported by the facts.”

The audit found $13 million of “suspicious” Medicaid claims during a one-year period that covered more than $2 billion worth of expenditures. Medicaid is the federal and state tax-dollar funded program that provides health care to low-income residents.

“What the data suggests is the need to run a tighter program, and that’s exactly what we’ve begun to do,” Nielsen said. “Most of the audit period occurred prior to the time that the KHPA assumed responsibility for managing Medicaid. I think policymakers will be pleased with the progress we’re making to improve the program.”

The audit was released Friday at a time when lawmakers are searching for ways to save revenue because of staggering budget deficits.

State auditors reported finding numerous questionable claims for Medicaid payments, including one for $941 for a Cesarean section for an 8-year-old boy. KHPA officials said that example was a data entry error and was never paid.

Auditors said they found about $10 million that was apparently paid for health care 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.

And the audit cited problems in dental claims, including 31 instances where a client received 20 or more dental procedures in a single day.

But Nielsen said some of the questionable Medicaid claims were based on data entry problems or where certain pieces of information, such as a Social Security number, seemed missing.

“We were pleased that the LPA found no evidence to suggest any of them are the result of unethical or intentionally criminal behavior,” she said.

Nielsen said KHPA recognized the state’s budget problems and is committed to helping find solutions, but added that the process needed “solid, data-driven analysis, not anecdotes or cursory reviews.”

Comments

Leslie Swearingen 5 years, 4 months ago

Data entry workers are human and they make mistakes. After typing in thousands of names and numbers for eight hours I can understand this. A few doctors can't resist temptation. A few doctors in this town make assumptions about the kind of person that would use Medicaid and if they are gracious enough to accept it, think they are entitled to a bonus. There are doctors that are very good to everyone regardless of social position. But I had to go to Ottawa to have my cataracts taken care of because not one doctor in Lawrence would help me. Understandably the media picks the most lurid mistakes to print.

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