Finding Fraud in Wisconsin Medicaid

Other concerns noted by some members of the Joint Audit Committee was fraud, something that DHS has recently become quite fervent about combating. Rep. Samantha Kerkman, the Committee’s Assembly Co-Chair, mentioned anecdotal evidence of people coming up from Illinois and using Wisconsin programs.

In fact, the Audit Report revealed an almost negligible amount of fraud against Wisconsin’s Medicaid system by program participants. “We agree that the State should combat fraud,” said Bobby Peterson, Executive Director of ABC for Health in his testimony at the public hearing, “but we disagree about what fraud needs to be combated. DHS never produced an evidence base to justify hiring all of these fraud investigators to go after beneficiaries.” Peterson asked just how fraud investigations would proceed in the jurisdictions of the committee members, asking, "Is this a DHS-sponsored witch hunt for fraud?" Peterson specifically focused his comments on fraud related to program beneficiaries.
Rep. Andy Jorgensen asked if DHS would commit to annual LAB audits, but neither Smith nor his Deputy Kitty Rhoades agreed to the idea at the hearing.
Fraud isn’t the only issue here. The Audit Report also showed that DHS has some serious budgeting issues. In the last year, Medicaid deficits have bounced from $553 million to $223 million, and now $141 million. At the same time, DHS engineered a waiver proposal that would affect the lives of tens of thousands of Wisconsin citizens. “They’re just guessing,” says Peterson, “and the people of Wisconsin deserve more accurate budget numbers for their health care programs.”
Click Here to read the HealthWatch Reporter on the topic of the Medicaid Audit Report.