AG Morrisey provides a progress report on the Medicaid Fraud Screening Unit transferred to his office in 2019 [The Dominion Post, Morgantown, W.Va.]

Nov. 30—MORGANTOWN—Attorney General patrick morsey offered a first look at the work of Medicaid Fraud Enforcement Unit who was transferred to his office in 2019.

During a virtual press conference organized from the East Sleevehe reviewed how the number of investigations, case closures and monetary recoveries have all increased since his office took over operation of the Department of Health and Human Resources.

He also announced that the office will now include fraud investigations under the Children’s Health Insurance Program – CHIP.

Morrisey started with a bit of history. It made sense, he said, for a single state office to prosecute cases of fraud, waste and abuse. In 2015, he opened the Disability Fraud Unit, which got $35 million in savings.

So he spent the next few years persuading the Legislature to move DHHR’s Medicaid unit to his office, and that happened in 2019.

The set up of the unit, he said, happened during the COVID pandemic which hampered its start. For example, they could not do on-site investigations.

So while the numbers aren’t as high as they could be, they’ve made progress, he said. Low pay was a barrier they removed, and they increased the unit’s staff from 12 to 21, and they plan to hire more. Most surveys focus on suppliers.

He showed some numbers to demonstrate improvements. Since 2019, his office has opened an average of 90 fraud investigation files per year, compared to 50 for DHHR. They opened 24 abuse and neglect cases a year, compared to nine for DHHR.

They closed more than 70 fraud cases a year, compared to just over 50 for DHHR, and 22 abuse and neglect cases compared to 13 for DHHR.

Reports of fraud rose from 130 to nearly 180, and reports of abuse and neglect from 120 to 500.

“We run the railroad quite well,” he said.

The unit also brings in more money, he said: $25 million of civil recoveries per year, against $6 million. “We have made fighting healthcare fraud a top priority in our office.”

He explained the new development of CHIP. Since 2000, he said, federal law has allowed state Medicaid units to investigate CHIP fraud, and now that that unit is up and running, he has sought and obtained permission from the United States. Health and social services to pursue it here.

CHIP costs approx. $48.8 million per year, he says, more $3.7 million in administrative costs, so there may be a few millions of fraud to be found there.

Going back to the program as a whole, he concluded, “Whatever you think of Medicaid fraud, we are pursuing it more aggressively, with more success than in the past. But that shouldn’t be seen as a ceiling, a lot more work needs to be done.”

TWEET David Beard @dbeardtdp EMAIL dbeard @dominionpost.com

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