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Medicaid Inspector General: 2024 complaints rise; audits of prior authorization and school reimbursements underway
Summary
Medicaid Inspector General Steve Anderson reported increased complaints in 2024, detailed investigations into impossible-hours billing and audits of prior authorization and Medicaid payments to schools, and said some identified savings — including a $12 million state general‑fund impact — require agency action to realize.
Steve Anderson, Kansas Medicaid Inspector General, presented the office’s 2024 annual report to the committee, which included complaint volumes, ongoing audits and examples of alleged provider billing abuse.
Anderson told the committee the office processed 1,454 complaints in calendar 2024, with 1,318 involving allegations of eligibility fraud. He said beneficiary non-eligibility fraud and provider-related complaints also continue, and described categories of preliminary case outcomes (no fraud/no jurisdiction; sent for review to clearinghouse; opened investigations).
“We look at it and we find that there’s nothing there,” Anderson said of the no‑fraud determinations; he emphasized many complaints are resolved after preliminary review.
Anderson outlined two performance audits nearing draft release: a prior‑authorization audit covering Jan. 2021–Dec. 2022 and an audit of Medicaid reimbursements for schools covering Jan. 2021–Jan. 2023. He said Kansas currently pays about $25 million a year in fee‑for‑service school claims that may overlap with capitation payments to managed care organizations (MCOs), and suggested shifting some school billing to MCOs could reduce duplication of payment.
He also gave examples from fraud investigations, including “impossible hours” billing where providers billed more than 168 hours per week, and an investigation that identified over $7 million in questionable claims. Anderson said the office has identified a range of potential recoveries and savings — including a $12 million annual state‑general‑fund savings tied to reassessment of continuing care retirement center assessments — but noted his office can only make recommendations; agencies or the legislature must act to recover or permanently realize savings.
Committee members asked how much identified waste has been actually recouped; Anderson said some savings are already realized when agencies change assessment or billing practices but that many recommendations require agency follow‑up. He also described coordination with KDHE clearinghouse staff and said expanded staffing would allow his office to pursue more criminal investigations when appropriate.
