Topeka The Kansas Medical Society on Wednesday strongly criticized a recent state audit that alleged numerous suspicious billing claims in the state’s Medicaid program.
Jerry Slaughter, executive director of the nearly 5,000-member KMS, told a legislative committee that the report by the Legislative Division of Post Audit contained serious deficiencies and unsupported allegations.
The audit did “a disservice to the hard-working primary care physicians of this state who serve the Medicaid population,” he said.
The audit questioned approximately $13 million in Medicaid expenditures. Medicaid is the state and federal taxpayer-funded health care provider for low-income residents. The program costs about $2.5 billion each year in Kansas.
Slaughter said one part of the audit suggested nearly 25 percent of claims for physician office and emergency room visits had been “upcoded,” or billed Medicaid for a more costly service than was actually provided.
Slaughter said the allegation was without merit because auditors didn’t examine any medical records associated with the claims, nor did the audit staff have any medical expertise.
The audit used a method called “data mining” that looks for statistical data that may identify potentially unusual claims.
Scott Frank, audit manager for the Division of Post Audit, said the purpose of the audit wasn’t to make allegations of fraud but to raise red flags for state health officials to investigate further.
“We think it does point to areas where there are potential problems,” Frank said. “We were careful to say we didn’t identify fraud.”
The audit has stirred controversy since its release last month.
The Kansas Health Policy Authority, which administers Medicaid, has been critical of the report.
After hearing a presentation on the audit and then from Slaughter, state Sen. Jim Barnett, R-Emporia, and chairman of the Senate Public Health and Welfare Committee, said the audit was incomplete.
“If they’re really interested in drilling down to find out if there is fraud and abuse or upcoding of services, they need to actually open medical records and look at the charts,” said Barnett, who is a physician. “They also need to have someone who is doing the audit with expertise in health care.”