Medicaid fraud costing the state $170M
JEFFERSON CITY, Mo. — On Friday, Governor Mike Parson met with members of the Department of Social Services, the Office of the Attorney General, the Department of Health and Senior Services, the Department of Mental Health, Missouri Health Care Association leaders, and partners from the Health and Human Services Office of the Inspector General to prepare to coordinate a Medicaid Fraud and Abuse Task Force.
“Safeguarding the integrity of the Missouri Medicaid program (MO HealthNet) is vital to the state of Missouri,” said Governor Parson. “Nearly one-third of Missouri’s entire budget is devoted to the Medicaid program, and it must be run with the highest level of integrity to ensure every tax dollar spent provides the care eligible Missourians need.”
State members will be working closely to identify opportunities to find ways to prevent fraud and abuse through data analytics and cost-effective deterrence measures, to make policy and legislative recommendations, and to create processes to optimize the prosecution and collection of improper Medicaid payments.
“The Department of Social Services is working diligently to protect the integrity of the Medicaid program. We must do more, and we cannot do it alone,” said DirectorSteve Corsi, Psy.D., Department of Social Services. “We deeply value the participation of all the members of the working group. Each of these leaders knows it is imperative for the Medicaid program to uphold the public’s trust and thanks to their expertise and insight, we are committed to finding new and better ways to end Medicaid fraud and abuse.”
“Governor Parson wants Missouri to be a national leader in addressing Medicaid fraud and today was an outstanding first step to see where we are, where we need to go, and how to get there,” said Todd Richardson, Director, MO HealthNet Program. “We will embrace innovative ideas to maximize current resources, think outside the box, and use new technologies to address the issue.”
Governor Parson recently appointed Richardson as MO Healthnet Director, a role which administers more than 60,000 MO HealthNet-enrolled healthcare providers and approximately 935,000 Missouri Medicaid program participants.
“The Department of Health and Senior Services is committed to getting resources to people who need them the most. Part of that responsibility is to make sure those resources are used appropriately and to ensure the integrity of this program,” said Director Randall W. Williams, MD, FACOG, Department of Health and Senior Services.
“The Department of Mental Health supports Governor Parson’s vision and is committed. It’s important to ensure an efficient system for the delivery of services for Missouri’s citizens that does not waste a single taxpayer dollar,” said Director Mark Stringer, Department of Mental Health.
“Missouri Care is firmly committed to the integrity of its relationship with the state of Missouri and to providing access to high-quality healthcare to its MO HealthNet members,” said Lou Gianquinto, President, Missouri Care. To meet the highest standards of ethical conduct, we continually analyze and investigate suspicions of fraud, waste or abuse and, if confirmed, take swift and decisive action to remediate.”
“Home State Health works diligently each day to ensure we fight against any and all acts of Medicaid fraud,” said Nathan Landsbaum, President and CEO, Home State Health. “We have extensive policies and procedures in place that work to detect fraud. We work proactively with DSS and the Attorney General to ensure these policies and procedures identify and resolve any potential risks to the program itself. Ultimately, this work continuously protects members as well as taxpayers.”
“United Healthcare enforces a zero-tolerance policy toward any form of fraud, waste, and abuse in the Medicaid system and collaborates with State and federal agencies such as the Federal Health Care Fraud Prevention Partnership and the National Health Care Anti-Fraud Association to make certain that tax dollars are appropriately spent,” said Jamie Bruce, CEO of United Healthcare Community Plan of Missouri.
The Department of Social Services and Missouri Medicaid Audit and Compliance Unit investigated Medicaid provider fraud and during SFY 2018 was responsible for more than $26.5 million in cost avoidance and $13.1 million in actual recoveries for the Medicaid program. The Welfare Investigations Unit investigates Medicaid beneficiary fraud and conducted more than 733 fraud investigations in SFY 2018. The Medicaid Fraud Control Unit in the Attorney General’s Office investigates and prosecutes provider Medicaid fraud.