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Massive Medicaid Fraud Uncovered In Kentucky

Medicaid Fraud
"None of these people are even citizens, what's going on here?"

According to the latest audit report from Medicaid’s inspector general, around $72 million was fraudulently paid to beneficiaries in Kentucky.

The audit revealed that the state agency in Kentucky did not follow federal and state policies and requirements to determine the eligibility status for Medicaid benefits. Furthermore, it was found that the agency does not possess any records of the verification of citizenship status – meaning illegals could have been pulling thousands in taxpayer funded benefits.

To provide Medicaid benefits, the state must conduct a thorough verification process through the Social Security Administration to verify nationality or citizenship status with supporting documentary evidence.

According to the audit, the state proceeded to provide Medicaid benefits without determining the eligibility status and required absolutely no documents to show that they had received a response regarding the citizenship status from the Social Security Administration.

“The state agency did not always meet Federal and State requirements when making eligibility determinations because of both human and system errors,” the report states. “The state agency did not always perform, or maintain documentation that it had performed, identity-proofing because of both human and system errors related to processes implemented in response to the ACA that affected eligibility determinations for non-newly eligible Medicaid applicants.”

“On the basis of our sample results, we estimated that during our 6-month audit period, approximately 8 percent of non-newly eligible beneficiaries in Kentucky were potentially ineligible, and approximately 3 percent of federal payments were made to those beneficiaries,” the report states. “As a result, we estimated that Kentucky made federal Medicaid payments on behalf of 69,931 potentially ineligible beneficiaries totaling $72,763,721.”

The auditors have recommended that Kentucky start following the proper process and require potential beneficiaries to show verified identities and citizenship, and also keep records and documentation of such verifications. Commissioner of the Kentucky Department for Medicaid Services agreed to implement the auditors’ recommendations.

“Kentucky Department for Medicaid Services agrees that due to system and human error citizenship or qualified alien status verification was not maintained,” said Stephen Miller, commissioner at the state agency. “When informed of the issue, the Department for Medicaid Services utilized staff communications and training to reinforce correct procedures.”

“The state appreciates the opportunity to comment on your recommendations,” Miller said. “We believe the issues identified have been successfully corrected.”

However, this is not the first audit to come back with shocking results. Back in 2015, an audit of the Social Security Administration showed that almost $20.2 million was paid in Social Security benefits to over 133 ex-Nazis from February 1962 to January 2015.


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