State audit uncovers $800 million in inefficiencies within Kentucky's Medicaid Services department.
State Auditor Allison Ball released a special examination of the Kentucky Department of Medicaid Services (DMS) on Wednesday, revealing that the department made unnecessary payments amounting to approximately $800 million over four years.
The examination focused on payments made by DMS to Managed Care Organizations (MCOs), which are similar to premiums paid by privately insured individuals to their health insurance providers. The special examination was the latest in a series of issues uncovered by the Auditor, including the failure to ensure ineligible noncitizens did not receive Medicaid benefits, the failure to prevent the same Social Security Number from being used by multiple Medicaid claimants, and the failure to complete inspections of over 100 long-term care facilities in Kentucky.
The unnecessary payments were part of a series of bureaucratic negligence within the Kentucky Department of Medicaid Services. The examination found 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. Furthermore, DMS failed to verify if it was duplicating payments made by other states, a new issue uncovered during the examination.
This failure led to about $800 million worth of unnecessary capitation payments to MCOs across four years (from January 1, 2019, to December 31, 2022). The examination also found that DMS failed to check for and investigate alerts from the federal government warning that double (or more) payments were occurring.
The search results do not provide information about the person responsible for monitoring duplicate payments to the Managed Care Organization in the Kentucky Medicaid program or the date of the last review of these procedures. Some of the long-term care facilities were last visited in 2019.
The full report of the special examination is available at www.auditor.ky.gov.
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. The unnecessary payments uncovered in this examination highlight the importance of proper oversight and accountability within the Kentucky Department of Medicaid Services.
