By O. Kay Henderson (Radio Iowa)
A task force appointed by the governor is recommending a more than 60% increase in the number of state employees who investigate Medicaid fraud allegations. The group also recommends using better technology, including artificial intelligence, to detect fraud patterns in the bills health care providers submit for Medicaid reimbursement.
Iowa Attorney General Brenna Bird was the task force chair. “This is not the finish line. This is the starting line,” Bird said. “Our message today is unmistakable. Iowa has zero tolerance for anybody who would steal from the taxpayers or exploit vulnerable people who are on Medicaid.”
Governor Reynolds issued an executive order in July, directing the task force to come up with a list of ideas by the end of October. The group said services like in-home care visits should be electronically verified. Iowa Solicitor General Eric Wesson helped write the report, which will be submitted to the governor before it is released to the public. “Fraud today hides in data,” he said, “so that is where our fraud fighters must look to find it.”
Bird said Medicaid fraud should become a felony, just like private insurance fraud, and payments to health care providers that are credibly accused of fraud should be immediately suspended during an investigation. “Iowa’s fraud unit already brings more criminal cases per employee than any other unit in the country, but it has just nine people policing an $8.7 billion program,” Bird said, “so our recommendation is to grow that to 24 (employees), with dedicated prosecutors, investigators, data anlysts and a nurse investigator.”
Critics say these proposals could and should have been implemented years ago. Kevin Techau led the state agency that investigated Medicaid fraud from 1999 to 2003, when Democrat Tom Vilsack was governor. “The Medicaid Fraud Unit could have accepted more federal dollars 10 years ago…and Kim Reynolds said, ‘No, we’re not interested,’” Techau said after the task force adjourned.
The federal government pays 75% of the salaries for the state employees who investigate Medicaid fraud allegations. And Techau faulted Governor Reynolds for putting a representative of the managed care industry on the task force and for not including the state auditor’s office, which is led by Rod Sand, the Democratic candidate for governor. “That’s a big tell that this was all political theater and was not a real effort to try to get to the bottom line of Medicaid fraud,” Techau said.
Some of the task force recommendations can be implemented before Governor Reynolds leaves office, but other ideas like hiring more state employees and increasing the penalty for Medicaid fraud must be approved by the Iowa legislature and Iowa’s next governor in 2027.
