Wednesday, Dec. 21, 2005
Contact: Spence Jackson, 573-751-0290
Blunt Commends Senate Leadership for Focus on Social Welfare Provider Fraud
JEFFERSON CITY–Gov. Matt Blunt today commended Senate leaders for forming a special committee to review social welfare provider fraud and said he looked forward to working with them to build on the more than $120 million in fraud his administration detected and saved taxpayers since January.
"I have consistently said that waste, fraud and abuse in our social welfare system was preventing low-income Missourians from getting the care they deserve," Blunt said. "Addressing fraud simply was not a priority in state government and previous administrations chose to let it grow unchecked. Our efforts have reversed that mindset and secured millions of dollars in savings for Missouri taxpayers.
"I look forward to working with the General Assembly to expand our efforts to fight provider fraud and to ensure that those who are currently on our social welfare rolls are eligible to receive the services so that our most vulnerable citizens are not cheated."
The Division of Medical Services (DMS) Program Integrity Unit has ramped up efforts to review Medicaid payments through systematic efforts to review provider payments before and after they are made. Working with a contractor, Thomson Medstat, an automated data system was implemented in the spring that increased cost avoidance and cost recoveries from $3,085,835 for the months of January through October 2004 to $7,959,724 for the same time period this year – an increase of 157 percent.
The Third Party Liability Unit of DMS has also worked diligently to maximize payments from other insurance companies diverting costs away from the Medicaid program. Third Party Liability recoveries for January through October of 2004 were $29.9 million compared to $42.2 million for the same time period this year – a 41 percent increase.
Other DMS savings include a new arrangement with medical equipment providers to discontinue the practice of renting breathing machines for Medicaid recipients needing this equipment to assist breathing during sleep. DMS has instituted an arrangement wherein total rental payments do not exceed the purchase price of the machines for an annual cost savings of $2.4 million.
The Department of Social Services (DSS) recently took action against a Springfield area daycare owner for allegedly submitting fraudulent claims for reimbursement. Other fraud investigations against providers are pending.
Additionally, during his first month in office Blunt ordered DSS to reinvestigate the continuing eligibility of all Medicaid recipients annually. At that time only about 70 percent of cases were current with the department's annual review policy. Since that time, the Family Support Division has increased its reinvestigation rate to 93.8 percent. More than 53,000 Medicaid cases have been closed. Adjusted for the amount of cases that may return to the rolls, the estimated annual savings is $267 million with $104 million being state funds.
"The Family Support Division has achieved this accomplishment in less than the estimated time frame. While we anticipated that this would be completed by June of 2006, the division is on track to reach 100 percent reinvestigations very soon. We are very proud of our employees for this stellar performance," said Department of Social Services Director Gary Sherman.
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