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Kansas Inspector General sees rising Medicaid complaints, urges MCOs to provide EOBs to beneficiaries
Summary
Kansas Office of the Inspector General reports rising fraud-related complaints in the Medicaid program and recommends managed-care organizations send beneficiaries explanation-of-benefit notices to help uncover fraudulent claims.
Steve Anderson, Kansas inspector general, told the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight on July 9 that complaints alleging fraud, waste and abuse related to the Kansas Medicaid program have climbed sharply. Anderson said his office had received 758 complaints so far in 2025, about 95 more than the same point in 2024, and noted the office processed 1,454 complaints in calendar year 2024.
Anderson said the majority of complaints the OIG receives concern eligibility fraud. He told lawmakers his office received a budget enhancement this fiscal year that allowed three additional staff dedicated to Medicaid work. The OIG also requested statutory changes to expand its investigative authority under KSA 75-7427 to include cash and food assistance programs.
A central recommendation Anderson presented to the committee is that Kansas’ managed-care organizations (MCOs) should issue explanation-of-benefit (EOB) notifications to Medicaid beneficiaries. Anderson said two of the state’s three MCOs — UnitedHealthcare and Sunflower — do not give EOBs to Medicaid recipients, while the third, Healthy Blue, does. He said EOBs are a major source of fraud referrals in private insurance because they let patients see billed services and spot discrepancies.
"Issuing clear directives to Kansas MCOs by providing consistent EOB statements to Medicaid recipients could help uncover fraudulent claims," Anderson said. He added that beneficiaries might be unaware their Medicaid ID is being used fraudulently for claims unless they receive EOBs or know how to check online portals.
Anderson gave the committee an example of a beneficiary who had falsely claimed pregnancy to obtain Medicaid and food assistance benefits; the defendant entered a guilty plea and was sentenced to probation and ordered to pay restitution.
Legislators on the committee asked whether Kansas could require MCOs by contract to issue EOBs. Anderson said federal Centers for Medicare & Medicaid Services (CMS) sets baseline rules, but states can add requirements via contract. "If the state wanted the MCOs to do it, they could require them to do it by their contract," he said. Senator Peck and Representative Sutton suggested the committee consider legislation or contract changes to require EOBs to strengthen fraud detection.
Proponents say EOBs would produce more referrals to investigative offices and make it easier to spot provider billing errors or identity misuse. Opponents and implementation questions identified by the committee include the cost and mechanics of requiring EOBs for populations that may have limited portal access or varying digital literacy.
What the OIG said it is doing: finalizing a performance audit of MCO prior authorization processes (covering Jan. 1, 2021–Dec. 31, 2023) and recently publishing an issue brief on whether Kansas Medicaid recipients receive EOBs. The inspector general’s office also briefed KDHE on a recommended centralized webpage to track policy-change documents; KDHE has since posted historical summaries of policy changes where the OIG suggested.
The OIG’s recommendations will be considered by KDHE and the committee as part of continued oversight and potential contract or statutory changes.
Ending: The OIG’s data-driven push to expand beneficiary access to EOBs is likely to draw interest from lawmakers seeking new tools to detect fraud. Any change will require KDHE and the MCOs to align on process, timing and funding.
