Jun 21, 2023, 14:29 PM
by
Kansas Attorney General's Office
TOPEKA – (June 23, 2023) – The Kansas Medicaid program may have overpaid more than $1.3 million to managed care organizations from 2019 to 2021, according to a performance audit of the Kansas Department of Health and Environment conducted by Medicaid Inspector General Steven D. Anderson.
“It’s clear from our audit that the federal government and the state can do more to recapture these overpayments by quickly identifying and verifying Medicaid beneficiaries who move out of state, and then by removing them from the program,” Anderson said. “Kansas taxpayers deserve to know that our Medicaid resources are being used efficiently.”
The performance audit reviewed eligibility determinations for Medicaid recipients that had moved out the state of Kansas but were still enrolled in the Kansas Medicaid program. The audit covered the period from January 1, 2019, through December 31, 2021. The number and types of findings identified that the federal information source state Medicaid programs rely on to identify members that have moved to other states does not provide the information as quickly as states need it to avoid paying for members who have moved. The audit also identified some control weaknesses, policy issues, and gaps in guidance or protocols for coordinating the assessment and collection of any overpayments related to out-of-state residency that Kansas needs to improve.
“Governor Kelly and I appreciate the ongoing partnership with the Attorney General’s Office to further our mutual goal of making the Medicaid program more efficient,” said KDHE Secretary Janet Stanek. “We agree that with the limited state and federal information sources available to the Medicaid program, challenges remain in the timely determination of whether or not a Medicaid beneficiary has moved out of state is very difficult with the information sources available to us. We would welcome the opportunity to gain more tools to help in that work but will continue to adjust protocols and policies within our control related to overpayments.”
The report concluded that KDHE, the agency responsible for administering the Medicaid program, has external factors and internal deficiencies that hinder KDHE’s ability to identify, verify, and terminate Medicaid eligibility on a timely basis. For example, a group of beneficiaries that were identified as moving out of Kansas were not properly processed, resulting in an estimated overpayment of $1,370,376.68 in capitation payment to the state’s managed care organizations (MCOs).
The Office of Medicaid Inspector General (OMIG) is required by K.S.A. 75-7427(k)(1) to make provision to solicit and receive reports of fraud, waste, abuse and illegal acts in such programs from any person or persons who shall possess such information.
The
report was submitted to Kansas Attorney General Kris W. Kobach, Secretary of Health and Environment Janet Stanek, KDHE Medicaid Director Sarah Fertig and the members of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight.
The reports are available at
https://ag.ks.gov/medicaid-ig.
To report suspected fraud, waste, abuse, or illegal acts involving the Medicaid, MediKan, or the State Children’s Health Insurance Program, citizens may use the online form at
https://ag.ks.gov/medicaid-ig or call (785)296-8637.