State audit uncovers $800 million in potential redundancies within the Medicaid Services of Kentucky.
State Auditor Allison Ball has released a special examination of the Kentucky Department for Medicaid Services (DMS), uncovering a significant issue that led to the erroneous payment of approximately $800 million in taxpayer dollars over four years (from January 1, 2019, to December 31, 2022).
The examination focused on capitation payments made by DMS to Managed Care Organizations (MCOs), similar to premiums paid by privately insured individuals to their health insurance providers. The findings reveal that DMS failed to check for and investigate alerts from the federal government warning that double (or more) payments were occurring. This failure led to unnecessary capitation payments to MCOs.
The examination also uncovered that DMS did not take basic steps to ensure it was not duplicating payments made by other states once a recipient moved out of Kentucky and enrolled in another state's Medicaid program. Some of these long-term care facilities were last visited in 2019.
The person responsible for leading DMS, accused of wasting over 800 million US dollars in taxpayer money due to this specific failure, is Lisa Lee, Commissioner of the Department for Medicaid Services.
It is important to note that all states must check for and investigate alerts from the federal government warning that double (or more) payments are occurring. However, DMS failed to do so, leading to unnecessary capitation payments to MCOs, totaling approximately $800 million.
The examination did not find any instances of the same Social Security Number being used by multiple Medicaid claimants in the specific issue under review.
Medicaid is one of Kentucky's costliest programs, and it's essential that every Medicaid dollar spent is going directly to benefit Kentuckians in need of services, not being wasted due to bureaucratic negligence.
The full report of the examination can be found at www.auditor.ky.gov. This is the latest in a series of Kentucky Medicaid issues uncovered by the Auditor, including failures to ensure ineligible noncitizens did not receive Medicaid benefits, prevent the same Social Security Number from being used by multiple Medicaid claimants, and complete inspections of over 100 long-term care facilities in Kentucky.
The examination was conducted by State Auditor Allison Ball.
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