State House Sound Bites

Capitol reporter Katie Meyer covers Pennsylvania politics and issues at the Pennsylvania state capitol.

The State House Sound Bites Podcast is now called State of the State and is a part of PA Post, a digital-first, citizen-focused news organization to hold Pennsylvania’s government accountable to its citizens.

How to reduce Medicaid fraud? A grand jury has some ideas.

Written by Katie Meyer, Capitol Bureau Chief | Apr 15, 2019 10:45 PM
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Shapiro, flanked by fellow attorneys who are involved with prosecuting Medicaid fraud. (Katie Meyer/WITF)

 

(Harrisburg) - After an 18-month investigation into Medicaid fraud in Pennsylvania, a grand jury panel is suggesting state lawmakers make some changes to disrupt what they describe as "systemic" patterns of malfeasance.

Attorney General Josh Shapiro released the report.

He described one instance in which a woman misled caregivers assigned to help her daughter with autism--having them improperly report their work and inappropriately assigning them household chores.

"There was a young autistic girl that didn't get help because her mom wanted her house to be painted instead, or wanted errands run," Shapiro said. "That is unacceptable."

In another case, he said a caregiver who was simultaneously working at three behavioral health agencies and as a substitute special education teacher filed timesheets that reported impossible, overlapping service.

To rectify situations like those, the grand jury panel suggested individual caregivers get a unique number that is attached to their service reports, and be required to report the date and time of their service.

They also said the state Department of Human Services should create a standardized training program for those workers.

That would likely come with a price tag for the state.

Shapiro said from his perspective, it would be worthwhile to shell out some fraud-prevention money.

Over the last two years, he said his office has recovered more than $34 million in bad payments--but more than likely, they missed many others.

"There's a lot of fraud out there," he said. "Any tools we can put in place to try and reduce that fraud, and try and reduce the burden on our investigators and our attorneys? That's a good thing for the people of Pennsylvania."

Published in News, State House Sound Bites

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