The Missouri Department of Social Services has not reviewed the federal eligibility requirements of about 71% of Medicaid and Children’s Health Insurance Program (CHIP) providers. Failure to verify the information could lead to things like providers committing Medicaid fraud or doctors or other providers who are not licensed to care for these patients.
State Auditor Nicole Galloway, D, tells Missourinet an annual audit shows the agency continues to skip the verification process. The checks are a federal requirement because tax dollars are at play.
“The ultimate consequence is a loss of funding from the federal government,” she says. “I don’t want to be an alarmist here. That’s not something that’s going to happen tomorrow, but when these problems occur year over year, the federal government then has to get involved and figure out what’s going on here in Missouri.”
The state has nearly 58,000 hospitals, clinics, doctors and others providing care to Missouri Medicaid and CHIP patients. Galloway’s office performed a sample review of 43 and questioned $223 million in payments because they had not been validated.
“With over 70% of providers that have not been validated, their eligibility has not been reviewed, this becomes a reoccurring problem, a huge backlog for the department,” Galloway says.
In a 2016 state audit, 87% of providers had not been reviewed by the agency.
Missourinet’s request for a response from the Department of Social Services has not been returned as of Thursday evening.