Virginia Medicaid Fraud Control Unit Is On Its Job

To the Virginia Commissioners and Attorney General Kenneth T. Cuccinelli, the kids thank you, the people thank, and I thank you for opening your eyes to the future prospects of aggressively going after and recovering Medicaid Fraud in Child Welfare with the new vision of your Medicaid Fraud Control Unit.


Anything you need to fulfill your mission of going after child welfare fraud, just let me know.


Pay attention!  This is what an Attorney General is suppose to be doing!

Va. Medicaid paid out $39 million improperly in fiscal 2009

Richmond, Va. --

Virginia's Medicaid program had improper payments of $39 million in fiscal 2009, including $20.2 million from fraud, an interim study by the state's watchdog agency has concluded.

An additional $48 million in potential fraud or error was avoided by blocking improper claims before they were paid, according to the report by Ashley Colvin, an analyst for the Joint Legislative Audit and Review Commission.

Medicaid is the health-care program for the needy funded by federal and state governments. Colvin noted that the improper payments and blocked claims represent less than 2 percent of Medicaid spending inVirginia, which, in fiscal 2009, totaled $4.8 billion.

That made the Medicaid program the second-largest program in the state budget, behind funding for K-12 education.

But the report also noted that errors in eligibility determination likely have resulted in improper Medicaid payments. Federally required reviews in Virginia have shown that errors occur in almost 8 percent of eligibility determinations, the report said.

JLARC adopted the interim study with little comment. A final report is due in a year.

Taylor Thornley, a press aide to Gov. Bob McDonnell, hailed the report.

"This report highlights what Governor McDonnell has said before, that we can do more to find savings within Virginia's Medicaid program," she said.

She noted that the governor has appointed a Medicaid reform task force to examine the management of Medicaid claims and payments.

Greg A. Pane, director of the Department of Medical Assistance Services, which administers the state program, concurred with several of the JLARC recommendations.

"We have had significant focus on program integrity at DMAS for the last several years," he said.

But the report says DMAS "appears to lack necessary resources to fully pursue Medicaid fraud." Funding for the department's fraud-pursuit program was cut beginning in fiscal 2008 and was eliminated in fiscal 2009, the period from July 1, 2008, to June 30, 2009.

"While the state has controlled Medicaid fraud and error to some extent, there appear to be opportunities to further reduce improper payments in Virginia," Colvin concluded.

He also said some of the enforcement problems may result from the fact that responsibility for the Medicaid program's integrity is dispersed among too many federal, state and local agencies.

Recipient fraud may not be fully investigated and prosecuted, the report found. In fiscal 2009, 37 of 120 local social services departments did not investigate any cases of potential fraud, Colvin said.

Ninety-seven local departments did not refer any Medicaid cases to a commonwealth's attorney for prosecution, he added.

The report said the General Assembly may want to change the law to allow local Social Services offices to recover a portion of the funds they recover from Medicaid fraud. Currently, the money goes to the state.

Local offices can keep 25 percent to 35 percent of funds they recover from food-stamp fraud, and the number of food-stamp fraud cases investigated is much higher than the Medicaid investigations.

The report said improper Medicaid payments stem from several sources, including billing for unnecessary medical services, billing for an item that lacks documentation, using incorrect medical codes and failing to properly bill a third party, such as Medicare or private insurance.

"A lot of work still needs to be done," said Sen. Charles J. Colgan, D-Prince William, chairman of JLARC.

"It may take more than another year of study."

The report noted that 857,652 Virginians were Medicaid recipients in fiscal 2009. It said the program accounted for 27 percent of Virginia's budget growth from fiscal 2001 to fiscal 2010.

When the new federal health-care law increases eligibility categories in 2014, between 270,000 and 425,000 people will be added to the Medicaid rolls in Virginia, Colvin said.

Interim Report: Fraud and Error in  Virginia’s Medicaid Program

Commissioner's Draft: Interim Report: Fraud and Error in Virginia's Medicaid Program 2010