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OMIG and Attorney General outline coordinated strategy for detecting and prosecuting Medicaid fraud
Summary
The Office of Medicaid Inspector General and the Attorney General’s Medicaid fraud unit described detection, provider suspension, civil recovery and criminal prosecution processes, and said recoveries and investigations have increased with targeted data analysis and vendor partnerships.
Officials from the Office of Medicaid Inspector General (OMIG) and the Attorney General’s Medicaid fraud unit told the Medicaid subcommittee they use data analysis, audits and investigations to distinguish mistakes from intentional fraud, to suspend suspicious providers, recover improper payments, and refer cases for civil or criminal prosecution.
Secretary Lisonbee Bragg said OMIG was established in statute in 2013 to centralize program-integrity functions and that the office uses audits and investigations to determine whether conduct appears intentional. "If we think somebody's stealing on purpose... we refer the case to the attorney general's office or another law enforcement agency," Director Samantha Blassingame said. OMIG officials explained they may suspend payments to a provider during an active investigation and pursue recoupment or corrective education where errors appear unintentional.
Senior Assistant Attorney General Justin Brasher and Deputy Tammy Harrelson described the Medicaid Fraud Control Unit (MAFU) as primarily responsible for criminal prosecution of provider fraud and for civil actions when criminal intent is not established. Brasher said MAFU has authority to prosecute neglect, abuse and exploitation in long‑term care when a Medicaid nexus exists and that criminal restitution awards are distinct from amounts collected. He added that the attorney general's office typically must be appointed as a special prosecutor by the local district attorney to file criminal charges.
OMIG and the AG's office noted coordination with DHS, federal partners and local prosecutors. Committee members asked about beneficiary fraud prosecutions, filing jurisdictions and suspension practices; officials said beneficiary fraud is typically handled by DHS referral to local prosecutors when appropriate, many criminal Medicaid fraud cases are filed in Pulaski County, and OMIG handles suspensions while civil suits generally do not trigger automatic suspension by the AG's office.
Both agencies pointed the committee to quarterly and annual OMIG/MAFU reports online for more granular breakdowns of amounts identified for recovery versus amounts actually collected. Officials said they would provide links and slide materials to committee members.
