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GOP demands answers on possible Medicaid fraud

January 31, 2019

Top congressional investigators sounded an alarm Thursday over potentially massive fraud in Medicaid and asked the Trump administration for a plan to combat overpayments, saying it’s possible that billions of dollars are being wasted on people who shouldn’t qualify.

Sen. Ron Johnson, chairman of the Senate Homeland Security and Governmental Affairs Committee, and Rep. Jim Jordan, the ranking Republican on the House Oversight Committee, issued their warning after an audit by Louisiana officials last year found up to 93 percent of new Medicaid beneficiaries may not have been eligible.

They asked Seema Verma, administrator at the Centers for Medicare and Medicaid Services, to look at Louisiana’s study and then figure out if that’s happened elsewhere.

“If these improper (over) payments are occurring in one state, it is logical to assume overpayments are occurring in other states,” the lawmakers wrote.

Louisiana’s legislative auditor, Daryl G. Purpera,picked a random sample of 100 Medicaid beneficiaries and found 82 percent should have been disqualified for at least part of their time on the rolls.

He also looked at a sample of 100 people whose incomes seemed suspect and, upon closer review, found 93 of them should have been deemed ineligible. Fourteen had annual incomes in excess of $100,000.

CMS has said it takes eligibility requirements seriously, but Mr. Johnson and Mr. Jordan said they had “concerns” about those assertions given data such as Louisiana’s audit.

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