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Medicaid Report
Auditors Say More Could Be Done To Stop W.Va. Medicaid Fraud
September 25, 2013

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Medicaid is a huge program in West Virginia. It is estimated that 350,000 people will get treatment in the state through Medicaid this year.

The latest report from the Legislative Auditor's Office found more can be done to investigate and stop Medicaid fraud.

The report was presented to legislators at a committee meeting today in the House chambers.

Back in 2007, there were a number of recommendations made to the Bureau For Medical Services and the Medicaid Fraud Control Unit.

Auditors said some progress has been made but that there are a number of important issues that still need to be taken care of. They include the need for more staffers to get rid of case backlogs and pursue fraud in court. Also, those additional workers could find ways to identify Medicaid providers with high billing error rates.

In other words, if there's smoke the auditors say the BMS and the MFCU should be looking for fire because millions of dollars are at stake.

"It's a substantial amount given the state's economic concerns at the moment," Derek Hippler, a research analyst with the Legislative Auditor's Office, said. "They've recovered, the MFCU has recovered $48 million from 2008 to 2011."

The report also concludes the BMS and MFCU should communicate better with each other. Auditors said if the two organizations are talking and working together they have a much better chance of catching providers who are overcharging the state.

If you would like to read the entire Legislative Auditor's report you can find it here.




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