During a recent government meeting, Medicaid Inspector General Steve Anderson provided an update on the operations and challenges faced by his office, particularly in combating fraud, waste, and abuse within the Medicaid program. Anderson highlighted the ongoing rise in complaints, with 1,447 cases processed in 2023, the majority concerning beneficiary eligibility fraud. He noted that 1,377 of these complaints were related to this type of fraud, underscoring a significant concern within the program.

The Inspector General's office has recently expanded its capabilities, having added two special agents last August, which has allowed them to conduct investigations into eligibility and provider fraud. Since then, they have opened 129 investigations, with 102 focused on eligibility fraud. Anderson reported that six cases have been referred for criminal prosecution, with several others nearing similar action.

Anderson emphasized the importance of disproving false allegations, stating that 14 cases were closed due to disproven claims, which he considered a positive outcome. He also mentioned that the office has identified substantial savings from removing ineligible beneficiaries from the program, amounting to approximately $150,941 in capitation payments over the past year.

Despite these efforts, Anderson expressed concerns about resource limitations, noting that the office currently has only nine staff members to manage a program serving over 400,000 people and costing over $5 billion. He plans to request additional funding for staffing in the upcoming legislative session to enhance the office's capacity to address fraud effectively.

Additionally, Anderson is conducting performance audits related to Medicaid processes, including prior approvals for hospital services and reimbursements for schools, which could lead to further efficiencies and savings. He provided a specific example of a case involving a beneficiary who fraudulently claimed benefits while residing in Oklahoma, illustrating the complexities of managing cross-border Medicaid claims.

The meeting concluded with Anderson open to questions from committee members, indicating a commitment to transparency and collaboration in addressing the challenges facing the Medicaid program.