Lawmakers on Wednesday criticized a audit of Medicaid saying it didn’t dig deep enough and worried it unfairly indicated that many primary care physicians were over charging the system.
In December, the Legislative Post Audit Division released a report identifying possibly fraudulent cases potentially costing the state up to $13 million. The $2.4 billion-a-year Medicaid program, provides health coverage to low-income people and covers more than 330,000 annually.
About 40 percent of the money comes from state funds, while 60 percent is from federal grants the state administers.
One particular sore point was the finding of more than $1 million in suspicious payments to care providers, also known “as up-coding.”
Jerry Slaughter, executive director of the Kansas Medical Society, pointed out the numbers in the report indicated that one in four charges were suspicious or potentially fraudulent.
“It does a disservice to the people who take care of Medicaid patients in this state,” he told the Senate Public Health and Welfare Committee.
Because the audit did not look at medical record there was no way to tell if that was the case, he said. It was like trying to read a newspaper from far away – you can tell what it is but not what is in it.
The findings came out of a data-mining audit of 2006 Kansas Medicaid billings. The study used data processing techniques that look for anomalies in billings or cases, but do not delve into individual medical records.
Slaughter said fraud would be hard to commit in Medicaid because of the oversight the program received.
“There are organizations tripping all over each other doing audits of Medicaid,” he said.
While the Kansas Health Policy Authority currently oversees the program, most of the cases in the study were from before the authority assumed oversight, said Dr. Andy Allison, the Kansas Health Policy Authority’s Medicaid director. There have been many changes to the program since the authority took it over.
Some lawmakers noted that part of the suspect claims could be clerical errors, or legitimate medical services provided in unusual cases.
Sen. Jim Barnett, R-Emporia, who chairs the committee and is also a physician, said he felt the audit didn’t delve deep enough.
It was a good first step in trying to identify areas that need to be investigated,” he said. Barnett also noted that the report
He scheduled the informational hearing to allow committee members to ask questions about the findings.
The hearing Wednesday was information, although Barnett anticipated his committee would focus more on other Medicaid issues during the session, which started Monday.
A complete version of the audit is avalibe here: http://www.kslegislature.org/postaudit/audits_cc/08cc02a.pdf