Costly mistakes found in Virginia medicaid program

RICHMOND, VA (WWBT) – Medicaid mistakes are costing you, the taxpayer, money. So Virginia's watchdog agency at the Capitol is trying to rein in wasteful spending. Tuesday, lawmakers on the Joint Legislative Audit and Review Commission got an earful on what's wrong with the system, and how to fix it.

Medicaid is the largest program in the state's budget, and a report unveiled Tuesday explained that one out of every five medicaid recipients might not actually be eligible for the benefits they're receiving.

In addition, the report says, in the 2009 fiscal year, misspent dollars on medical services for the poor could've been as low as $18 million or reached as high as $263 million.

Lawmakers were told too many people are improperly enrolled in medicaid; the result of human error and an outdated filing system.

"Folks have gotta just pull the right binder up, find the right page, hope it is the right page and get out their calculator," said Ashley Colvin, JLARC's chief legislative analyst.

Lawmakers were also told that most of the problems are not happening on purpose. Medicaid fraud accounts for a relatively small amount of the money misspent, though Virginia has seen at least 100 fraud convictions since 2005.

Cynthia Jones is the medicaid program director.

"We agree that the eligibility process requires significant improvement," she told the commission.

There were several recommended solutions, including better internal controls and upgraded technology.

"If there wasn't TurboTax, I'd never get my taxes right. But we don't have anything even close to that for the Medicaid system," Colvin explained to the commission.

And now, there's added pressure. Expected changes in federal healthcare reform will add even more people to Virginia's medicaid system.

"It must be fixed prior to 2014 when we expect more than 400,000 new Medicaid clients to come on the roll," Jones said.

One out of five, or 20%, sounds like a lot. But in context, it's nothing compared to another state that had 70% of medicaid patients improperly enrolled. The identity of that state was not revealed.

Most of the medicaid recommendations made Tuesday require a state budget amendment in December, or a bill next year before they can be formally considered.

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