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State improving efforts to fight Medicaid & Foodshare fraud

by
Wisconsin Department of Health
Wisconsin Department of Health
Wisconsin Department of Heal... (Download MP3)

MADISON, Wis. (WSAU) - Wisconsin officials are making some changes to help stop fraud and abuse in the state’s Medicaid and Foodshare programs.

Kevin Moore is the Deputy Secretary for the Wisconsin Department of Health Services. He says Governor Scott Walker has worked with them to develop the new initiatives. Moore says these new provisions will be evaluated over the next couple of months and implemented

One of the changes began about two years ago. Moore says they created an Inspector General position and staff to do a better job of investigating fraud and abuse. “When this administration came in, there was one individual that was doing recipient fraud for Foodshare and for Medicaid. For programs that have upwards of a million people in it, that’s just not enough.”

Moore says they are now looking closer at the front end of the issue, when people apply for public assistance programs, to find both mistakes on forms & intentional efforts to commit fraud. “For some of the initiatives we’ve outlined, it may be as simple as just creating a special, dedicated unit to be able to evaluate applications, look for things in applications that may look a little suspect, and then allow us to continue on that investigation to determine whether or not, are they suspect or maybe it might be something as simple as they just mis-filled out the information.”

The state is also developing a business plan, and then will work on upgrading information technology solutions to cross reference data from other governmental divisions. “More about data sharing. More about making sure that we get a better, more holistic view of people when they’re coming in for eligibility. that the information they’re providing us, that we have access to the back end systems to verify that.”

Some programs have more fraud than others. Moore says there has been a dramatic uptick in people trying to defraud the Foodshare program recently, and they’ve been catching more people at it. “When we first came into office in the calendar year 2011, there were 105 suspensions from the Foodshare program. In calendar year 2013, we’re predicting 332 suspensions, so in two years, we’ve been able to almost triple that number.”

The Department of Health Services is also developing better ways to share other state data, such as unemployment and child care programs, since people that commit fraud are likely to do so in more than one program.

Department of Health Services staff will also be assisting people find the right program under the Affordable Care Act, also known as Obamacare. Moore says they will be working with income maintenance offices around the state to help guide people to the right programs and exchanges.

The Wisconsin Department of Health Services website has a place to report suspected fraud and abuse of programs. The website is dhs.wisconsin.gov. The toll-free tip line is 877-865-3432.

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