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Medicaid inspector general reports $6.5 million recovered and $13 million in projected cost avoidance for FY24
Summary
Gene Cottrill, the Medicaid inspector general, told the committee the Office of Inspector General (OIG) opened 354 cases in fiscal 2024, recovered $6.5 million and projected $13 million in cost avoidance; the office referred nine credible fraud allegations to the Medicaid Fraud Control Unit
Gene Cottrill, Medicaid Inspector General, presented the annual functions and recent results of the Office of Inspector General for Medicaid Services to the General Government Appropriations Subcommittee.
"Our mission is to protect taxpayer dollars by identifying fraud, abuse, and waste risks and vulnerabilities in the state Medicaid program," Cottrill said. He described the office's three sections: program integrity (post-payment reviews and preliminary investigations), audit (performance and financial audits of the single state agency) and mission support (data, policy, training and legal support).
Cottrill told the committee that in fiscal year 2024 the office projected cost avoidance of more than $13 million using a cost-avoidance methodology developed in 2018, opened 354 cases, and recovered $6.5 million in inappropriately billed Medicaid claims. He said the office referred nine credible allegations to the Medicaid Fraud Control Unit with approximately $90 million at risk.
Cottrill described audit and investigatory boundaries: the OIG conducts preliminary investigations and administrative recoveries but refers matters requiring criminal or civil prosecution to the Medicaid Fraud Control Unit. He also noted the office's staffing and funding constraints, saying much of the OIG budget is federally funded: the office's total spend last year was about $4.117 million, of which about $1.5 million came from state funds and the remainder from federal funds (FMAP).
The office reported a return on investment (ROI) of about 497% for the most recent year and an average ROI of about 807% since Cottrill became inspector general in 2016. He identified three main challenges: increasingly complicated fraud schemes (including those that may use artificial intelligence), evolving fraud tactics, and staffing difficulties for positions that require medical expertise.
Ending: Cottrill asked the committee to sustain the office's capacity to detect and mitigate fraud, waste and abuse and to consider staffing and technical needs to address emerging threats such as AI-assisted schemes.
