Medicaid Fraud
5:23 pm
Wed January 15, 2014

Mo. Medicaid Fraud Unit Recovers $47 Million In 2013

The state of Missouri recovered more than $47 million in fraudulent claims made by Medicaid providers in 2013.

That's about an average year for Attorney General Chris Koster's Medicaid Fraud Unit. The office has recovered as much as $100 million, and as little as $20 million, in a year.

Koster, a Democrat, says those wide variations are triggered by how much money Missouri receives from national settlements. But even though more national settlements means more money for the state's coffers, he says the fraud that concerns him the most is conducted by the smaller providers.

"These cases may only be $8,000, $10,000, $25,000 in size, but they are small-time providers who think that because they are only stealing a small amount of money they’re going to get away with it, and that’s not true," he said.

The state opened 205 fraud investigations last year. Of those, 48 resulted in either criminal or civil prosecution. The head of Saint Louis University's health law clinic, Tim Greaney, says a change by the federal government should make it easier to track down fraudulent claims by providers.

In the past, Greaney said, providers were automatically paid within 60 days of submitting a bill. If fraud was detected, investigators would try to track them down.

"Well often, the fraudsters have disappeared by that time," Greaney said. "So what they’re doing in the Medicare program is trying to have closer scrutiny of who gets to be a provider in the first place."

Koster says his office hopes to soon have a computer algorithm that can scan the state’s Medicaid budget to look for evidence of potential fraud.

According to federal data analyzed by the Transactional Records Access Clearinghouse at Syracuse University, the federal courts in southern Illinois and eastern Missouri were among the top 10 in prosecuting health care fraud.

Follow Rachel Lippmann on Twitter: @rlippmann