Report: WV could lose more than $200 million in federal Medicaid money

June 17, 2014 by Dave Boucher

West Virginia could stop receiving more than $200 million in federal Medicaid funding if it doesn’t stop sending payments to providers facing “credible” allegations of fraud, according to a new report provided to lawmakers today.

The information from the office of the West Virginia Legislative Auditor states the West Virginia Bureau for Medicaid Services sent almost $230 million to providers accused of several different types of fraud.

The data is an update to a previous report released by the legislative auditor in October 2013. The report said the state is ignoring a provision of the Affordable Care Act that requires suspending payments to Medicaid providers after the state determines an allegation of fraud is credible.

If the state continues to pay those providers after they’ve referred cases to the Medicaid Fraud Unit, it could stand to lose a significant amount of federal funding, according to the legislative auditor’s report.

The bureau, operating under the state Department of Health and Human Resources, disputed the auditor’s initial claims. Since the release of the report, the legislative auditor said the bureau argued it had received a “verbal statement” from the federal government that said they were not issuing payments inappropriately.

After the legislative auditor requested proof of any federal approval, the bureau said it had received a written document recently but “it cannot discuss the contents of the correspondence with anyone,” according to the auditor’s office.

The legislative auditor’s office recently received information from the bureau about the amount of money it’s paid to the 65 providers with fraud referrals included in the 2013 report.

“The (bureau) provided two sets of referrals for review, a provider referral and a caseworker referral,” reads a statement from the legislative auditor’s office.

” After review, (the bureau) has paid the providers with fraud referrals $17.9 million and caseworker referrals over $211 million.”

State lawmakers are scheduled to discuss the new information this afternoon.


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