AG IS TOO LAX WITH AUDITS OF MEDICAID PROGRAM

Medicaid is the largest single budget item in Missouri, yet it seems there is precious little oversight of the multibillion-dollar health care and disability program.

At a cost of $3.4 billion in state and federal funds for the fiscal year that began July 1, Medicaid serves nearly 15 percent of Missourians. The cost of the program jumped $500 million from the recently ended budget year -- a 17.2 percent increase -- and rose 56 percent over the past six years.

Despite this huge expenditure -- about $900 million more than the state has earmarked for elementary and secondary education -- only a handful of Medicaid providers are audited to ensure the money is being spent as intended. According to an audit by a division of the Office of Legislative Research, the system is ripe with opportunities for fraud, but less than 2 percent of Medicaid providers are ever reviewed.

In 1995, a unit was established by Missouri's attorney general, Jay Nixon, to recover fraudulent payments in cases referred to it by the Department of Social Services, which administers the program. However, auditors criticized the unit for not promptly investigating all cases, allowing some to languish untouched for up to two years.

The auditors suggested that all cases be reviewed within 90 days to improve the chances of successful prosecution. They also criticized the attorney general's office for not fully staffing the unit. Although the General Assembly has authorized 23 full-time employees for the unit, auditors found only 13 on the staff.

The auditors also found fault with the Department of Social Services for failing to have a strategic plan to detect and prevent Medicaid fraud, a charge the department denies.

Whatever the reasons for incidents of alleged fraud falling through the cracks in the past, state officials need to take immediate steps to seal those cracks now.