Medicaid could save millions by avoiding fraudulent billing, audit finds

June 13--State auditors say Ohio could save millions from its tax-funded Medicaid program with early detection of fraudulent billings.

Auditor Dave Yost says "by catching bad billings before they are paid" instead of trying to recoup payments afterward, the state could save $30 million.

The recommendation was included in a performance audit released yesterday of the Department of Job and Family Services, which until recently included the $18 billion Medicaid program providing health coverage to 2.3 million poor and disabled Ohioans. Medicaid is now a separate state agency.

Ohio Medicaid Director John McCarthy said program officials have already begun addressing concerns about fraud and abuse.

"Our current biennial budget proposal includes a series of measures that will increase Medicaid's audit and recovery capacities and ensure that millions in taxpayer dollars are accounted for," McCarthy said.

For instance, Gov. John Kasich's budget proposal includes the addition of five full-time Medicaid auditors to perform additional on-site monitoring to reduce overpayments.

Medicaid reimburses tens of thousands of doctors, medical-supply companies, hospitals and other health-care providers for services given to Medicaid patients.

The audit found that two-thirds of the potential savings could come through better oversight of home-health-care services. Telephone monitoring and verification of such services could reduce incidents of double-billing or billing for services never provided, saving Ohio nearly $20 million a year, Yost said.

The audit also suggest Medicaid could save $10 million a year if it required surety bonds from providers who historically are at greater risk of committing fraud -- home health-care providers, ambulance and ambulette services and durable medical equipment companies

ccandisky@dispatch.com

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