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Kentucky officials describe Medicaid program-integrity work, cite $251 million in 2025 savings
Summary
Department for Medicaid Services leaders told the Health Budget Review Subcommittee their program-integrity unit focuses on provider-driven fraud, prevention at enrollment, audits, payment suspensions and recoveries; officials said program efforts produced roughly $251 million in savings so far in 2025.
Commissioner Lisa Lee and Jennifer Dudinsky, director of the Division of Program Integrity at the Kentucky Department for Medicaid Services (DMS), described the state's efforts to identify and curb Medicaid fraud, waste and abuse during a Health Budget Review Subcommittee meeting.
Lee said Kentucky's Medicaid program is a federal-state partnership and outlined program size and spending. "Medicaid is a partnership between the state and federal government," she said. The department reported roughly 1,400,000 members on Medicaid, about 69,000 enrolled providers and combined 2024 expenditures of about $18.5 billion.
Program-integrity work focuses on provider activity rather than members, Dudinsky told the committee. She said member fraud accounts for roughly 2% or less of identified fraud and abuse, and most investigations and enforcement actions are provider-driven. "We have about 60 employees" in the program-integrity unit, Dudinsky said in response…
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