CHARLESTON — A state Senate bill would move West Virginia’s Medicaid Fraud Control Unit from the Department of Health and Human Resources to the Attorney General’s office.
Senate Bill 318 has been introduced and referred to the Judiciary Committee.
Attorney General Patrick Morrisey says the change would strengthen the state’s fight against Medicaid fraud. He also says the move would save taxpayers many millions each year and bring West Virginia in line with the majority of other states.
Currently, the unit is housed under the DHHR’s Office of Inspector General.
“Right now, 43 states have their Medicaid Fraud Control Units under the attorneys general,” Morrisey told The West Virginia Record. “This is not a controversial idea. It just makes sense to make this change.
“We have the disability fraud unit here already. We’d like to build on that. We have the expertise. We want to protect those people who need these Medicaid benefits.”
Morrisey said Medicaid is meant to provide medical care for low-income residents and families who need assistance. He said the bill’s passage would fix deficiencies in West Virginia’s existing unit and yield greater efficiency and effectiveness to the benefit of the taxpayer.
“A responsible government, accountable to its citizens, cannot condone such thievery,” he said. “It must attack waste, fraud and abuse at every level, and our effectiveness in rooting out more than $14.3 million in disability fraud proves the success we can have in fighting Medicaid fraud.
“We have relationships with the attorneys general in these other states. We can use those relationships to partner up with other states to make this unit even more powerful.
“We hope the stars align this session to make it happen. We’re optimistic and hopeful.”
Judiciary Chairman Charles Trump (R-Morgan) is the bill’s lead sponsor. Co-sponsors are Sens. Patricia Rucker (R-Jefferson), Sue Cline (R-Wyoming), Rollan Roberts (R-Raleigh), Dave Sypolt (R-Preston), Eric Tarr (R-Putnam), Bill Hamilton (R-Upshur) and Michael T. Azinger (R-Wood).
Last month, Morrisey’s office announced its disability fraud partnership has generated more than $14.3 million since its inception, including a record-breaking $6.2 million in calendar year 2018.
During a House of Delegates budget hearing last month, Morrisey touted the plan to take over the Medicaid fraud unit.
“I’m hopeful this is the year that folks take advantage of the savings opportunities and the quality you can bring to bear if you move that division and you are consistent with what 43 other states do,” Morrisey said.
On the DHHR’s Office of Inspector General’s website, it says the unit “is the single entity of West Virginia state government that is certified annually by the Secretary of the U.S. Department of Health and Human Services to conduct statewide investigations of health care providers that defraud the Medicaid program.”
The unit investigates complaints of criminal abuse or neglect in any health care facility, as well as allegations of misappropriation of patients' private funds in Medicaid facilities. The unit is also charged with the investigation of fraud in the administration of the Medicaid program.
Its website says the unit’s mission is “to protect West Virginia’s vulnerable citizens and the integrity of its health care program. In fulfillment of that mission, the MFCU investigates allegations of fraud in the Medicaid program and allegations of criminal abuse, neglect, or financial exploitation of residents in health care facilities or board and care homes.”
Under new director Mike Malone, the state’s current Medicaid fraud unit features eight investigators, two auditors and one data mining specialist. It has a budget of $1.88 million.
Morrisey also said Medicaid spending in the state totals more than $3.7 billion. That money is distributed by the DHHR. Morrisey also believes the agency handing out the money shouldn’t be the one investigating possible fraud.
“If one department is going to be spending such a significant portion of the state budget, it certainly makes a lot of sense to have a completely separate entity take a look at that and analyze the expenditures,” he said. “I think that alone, a fresh pair of eyes on a variety of issues, could result in savings.
“This is the second largest program in West Virginia. This is about budget savings, and I think it could be very beneficial.”
