Medicaid inspector general urges corrective-action plans after audits find millions in questionable payments

Steve Anderson, Medicaid Inspector General, told the Committee on Government Efficiency that his office has identified ‘‘fraud, waste and abuse’’ in the state Medicaid program and urged the committee to require corrective-action plans and give his office more resources and access to contracting documents.

Anderson said the state Medicaid program is ‘‘a $5,500,000,000 program per year’’ that served an average of ‘‘467,440 beneficiaries in a year,’’ and that his small office has produced audits that together contain 34 findings and 83 recommendations since 2021.

Anderson told the committee the office needs both more staff and formal mechanisms to force follow-up when agencies do not act on audit recommendations. ‘‘When we do an audit … sometimes the agencies agree with our recommendations. Sometimes they absolutely disagree, but there's no recourse,’’ he said. He recommended placing corrective-action plans on audit findings and adding those plans to existing trackers used by the Bethel committee so agencies must report progress.

Why this matters: Anderson said audits have identified sizable recoverable or avoidable costs. He cited three detailed examples presented to the committee: recouping capitation payments for members living out of state, expensive Life Alert bracelet billing practices within home- and community-based services (HCBS), and long-running overpayments tied to the…