Inspector General details rise in Medicaid eligibility complaints, flags pregnant‑woman claims and data cooperation plans

Inspector General Steve Anderson told the Health and Human Services Committee that complaints about Medicaid eligibility fraud are rising and that his office is expanding audits and investigations.

“We processed 1,557 complaints in 2025, with 1,352 involving eligibility fraud,” Anderson said, adding that fraud investigations now increasingly touch multiple public-assistance programs. He described a recent push to share information with the Department for Children and Families and other agencies under a planned memorandum of understanding so documents, EBT information and other records can be exchanged.

The OIG chief described several ongoing audits and investigations he said have uncovered significant potential overpayments. Anderson said his office is reviewing a group of 62 cases of benefit claims filed by people aged 45 and older who listed pregnancy and then had no health‑care claims; an initial sample of 28 such cases showed more than $230,000 in potentially improperly paid benefits tied to SNAP, WIC and other programs. “We’ll open criminal investigations on some of those depending on the amount of loss and the circumstances,” he said.

Anderson also previewed broader audit work on Home and Community‑Based Services (HCBS) waivers, functional assessments and pharmacy dispensing fees. He said an interim report found late or missing functional assessments in waiver programs — in one review 721 people had gone more than four years without required assessments, which the OIG concluded created program vulnerability and potential waste. On dispensing fees, Anderson said the state has spent about $16 million in dispensing‑fee payments over three years in circumstances that may include overuse of over‑the‑counter scripts.

Committee members asked about scope and scale. Representative Ballard asked whether some of the pregnant‑woman cases could be measured or prevented by adding photographs to beneficiary cards; Anderson said photograph ID could help reduce medical identity theft but that cost estimates were not available. Members pressed for better staffing and coordination: Anderson said his office had increased investigators but still could not pursue every case flagged by referrals.

Anderson emphasized that many audit findings reflect improved detection since the OIG gained authority and staff in recent years. “If you don’t look for something you’re not going to find it,” he told legislators, adding the OIG has opened hundreds of matters and continues to refer cases to county attorneys, the attorney general’s office and federal prosecutors when warranted.

Legislators asked the OIG to provide more detail on the sampling and methods behind the ID waiver wait‑list claims flagged in his presentation; Anderson said the 80% error‑rate figure cited for a sample of the ID wait list was preliminary and under verification and will be included in a final report.

What’s next: Anderson told the committee the OIG will continue publishing audit reports and work with other agencies to improve cross‑program data sharing and detection of eligibility abuse. Committee members asked follow‑up requests about how many cases are prosecuted, how much savings are confirmed by audits and what policy changes could reduce improper payments.

Speakers: Steve Anderson, Inspector General (Office of Inspector General).

Sources: Testimony to the Health and Human Services Committee, Kansas Legislature; OIG interim reports and committee Q&A.