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Kansas Medicaid inspector general flags billing, background-check gaps and school Medicaid audit savings
Summary
The Office of the Medicaid Inspector General reported investigations into nursing home fraud, a school Medicaid audit that could save an estimated $22.5 million annually, and systemic compliance gaps including missing background checks and impossible-hours billing.
Steve Anderson, Kansas Medicaid Inspector General, told the Bethel committee his office processed 1,454 complaints in calendar year 2024 and that 1,318 of those involved allegations of beneficiary eligibility fraud. He said the OIG has already processed more than 400 complaints so far in the current year and has filed 36 civil complaints related to what the office alleges were false bed-tax statements by certain nursing homes.
Anderson described a performance audit of Medicaid reimbursements tied to school-based services covering claims from Jan. 1, 2021, through Jan. 31, 2023. The audit found that Medicaid’s monthly capitation payments to managed care organizations may overlap with fee-for-service…
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