Medicaid inspector general flags suspected fraud, system failures and millions in potential savings

The Office of the Medicaid Inspector General told the Committee on House Health and Human Services on Tuesday that audits and investigations have uncovered suspected fraud in the pregnant‑woman Medicaid program, widespread process failures in home‑and‑community‑based services (HCBS) and examples of duplicate payments to managed‑care organizations.

Inspector Steve Anderson, presenting the office’s work, said an audit of the pregnant‑woman program flagged 62 people aged 45 and older who had no pregnancy claims and “appear to be fraudulently on the Medicaid or on the pregnant woman program.” He said capitation payments tied to those cases total nearly $800,000 and that the office intends to open criminal investigations into the most serious instances as staffing and prosecutorial resources permit.

The finding followed broader data reviews the office is conducting of DCF and KDHE eligibility information, Anderson said. He told lawmakers the audit team has seen cases in which applicants reported different employment or pregnancy status to separate programs — facts that, when inconsistent across SNAP, childcare subsidies and Medicaid, can create…