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DHHS program quality and integrity bureau reports audits closed, lower single-audit findings and ongoing fraud recoveries
Summary
DHHS’ Division of Program Quality and Integrity told the finance panel it reduced single-audit findings, closed LBA audits, and maintains program integrity efforts that identify overpayments and coordinate fraud referrals; bureau leaders said recoveries exist but many are returned to federal or other accounts.
The Department of Health and Human Services’ Division of Program Quality and Integrity presented an overview of internal audits, program quality work and program integrity functions to the House Finance Division 3.
Meredith Tullis, director of the division, described three units: the Office of Internal Audit, Bureau of Program Quality (data analytics, Medicaid quality information and program evaluations), and Bureau of Program Integrity (claims, provider investigations, third-party liability and financial compliance). Tullis said the division acts as a liaison during external audits and helps programs implement corrective actions.
Tullis said the department reduced single-audit findings from about 23 in earlier years to five in the most recent audit cycle and noted work that reduced SNAP error rates and closed several LBA audits. She also described program integrity activities that include provider enrollment checks, site visits, claims analysis and referrals to the state Medicaid Fraud Control Unit when criminal fraud is suspected.
Francesca Hennessy, fraud, waste and abuse administrator, said the program has about 50 active cases with the state Medicaid Fraud Control Unit; the program manages both provider-side and beneficiary-side investigations and separation of responsibilities between DHHS and the Attorney General’s Medicaid Fraud unit.
Tullis and Hennessy described recoveries as varied: some recoveries are retained as unrestricted revenue, others are remitted to federal or county funds depending on the source. The department said estate-recovery activity yields multi-million-dollar returns and staff argued that adding one attorney and two support staff to estate-recovery work could generate an estimated $2 million additional collections, of which the state’s net share was estimated at roughly $700,000 (estimates provided as illustrative and subject to confirmation). The bureau said it will supply a more detailed business case if the committee wants to consider funding additional estate recovery staff.
Ending note: Committee members asked for breakdowns of recoveries, the share returned to federal partners and how additional staff would affect net returns; bureau leaders agreed to provide more detailed recoveries accounting and a business-case estimate for adding estate-recovery personnel.
