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Auditor says state loses millions of dollars in Medicaid fraud

By Kristen Consillio

POSTED:
LAST UPDATED: 05:33 p.m. HST, Jan 17, 2014



The state has failed to put enough resources into curbing fraud, waste and abuse in its Medicaid health insurance program covering 290,000 residents, resulting in tens of millions of dollars in losses annually, a state auditor's report released today shows.

"As a result, Hawaii's detection and enforcement activities lag far behind national averages," the report said, citing a 2011 Centers for Medicare and Medicaid Services finding that improper payments from the Hawaii's Medicaid and Children's Health Insurance programs totaled $66.9 million.

The Department of Human Services expanded the Medicaid program more than a year ago to align with President Barack Obama's Affordable Care Act.

The expansion eliminated the asset limit for most enrollees as of Jan. 1 and raised income levels for eligibility, which has resulted in an increase of about 18,000 low-income residents into the program since Oct. 1.

"With state contributions to the Medicaid program nearly doubling over the past five years, legislators are understandably concerned about the relevance and usefulness of the information it currently receives from the division," the auditor said in the report.

DHS Director Patricia McManaman said in a written response to the auditor that the department is taking steps to eliminate fraud, specifically through a new $95 million eligibility system called Kolea, which will eventually connect with federal data hubs and the state Department of Labor and Industrial Relations to verify income and reduce errors.

"DHS believes that no fraud, waste and abuse is acceptable," she said in her response.

Read the report at http://files.hawaii.gov/auditor/Reports/2014/14-02.pdf.






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Mike174 wrote:
Duh! Just goes along with all the other fraud. Government sanctioned or no...
on January 17,2014 | 02:01PM
pcman wrote:
IMHO government fraud starts at the top. When the top person in charge is cheating, so will the subordinates, sometimes in a bigger way. Follow the trail of monies into everybody's bank accounts and there you will find the cheaters.
on January 17,2014 | 06:27PM
twitter6 wrote:
Too many people milking the system. Need enforcement and stiff penalties. Sick of seeing these clowns at the market with the EBT card, getting free car insurance, free milk and housing subsidy. I think they call it outright theft
on January 17,2014 | 02:21PM
Skyler wrote:
You left out doctors, physical therapy departments, hospitals, etc.
on January 17,2014 | 03:47PM
Mythman wrote:
Free car insurance? That's one I haven't heard of before. How does that work?
on January 17,2014 | 04:20PM
Skyler wrote:
Welfare & SSI recipients can get free no-fault insurance. If your income steps up to Social Security Disability, you're cut off.
on January 17,2014 | 06:55PM
control wrote:
Sadly, it costs money to hire and train enforcers. They are also the first group of people eliminated anytime there is a budget crunch along with janitors and maintenance people. They are seen as non-essential.
on January 17,2014 | 02:44PM
jayz43 wrote:
Ironically, even if enforcers were responsible for eliminating a fraction of the $66.9 million in wrongful payments it would pay for itself and put perpetrators and "wanna-be's" on notice.
on January 17,2014 | 05:59PM
Maneki_Neko wrote:
Good thing the Hawaii Health Connector doesn't work. Otherwise we would be enrolling more and more people into Medicaid.
on January 17,2014 | 04:05PM
pridon wrote:
State can hire a lot of investigators for $66 million.
on January 17,2014 | 05:04PM
soundofreason wrote:
You can only imagine my surprise. So.....who exactly is getting prosecuted?
on January 17,2014 | 05:49PM
Ronin006 wrote:
The censors at the Star-Advertiser are apparently gone bananas. This comment was sent for approval. “Fraud, waste and abuse are obviously rampant in Hawaii’s Medicaid program, yet I do not recall reading or hearing about a single person being tried and convicted of such crimes. Perhaps that is wide fraud, waste and abuse is so widespread – no one gets prosecuted.” What did I say that triggered the comment being sent for approval?
on January 17,2014 | 06:02PM
Ronin006 wrote:
Fraud, waste and abuse are obviously rampant in Hawaii’s Medicaid program, yet I do not recall reading or hearing about a single person being tried and convicted of such crimes. Perhaps that is wide fraud, waste and abuse is so widespread – no one gets prosecuted.
on January 17,2014 | 06:00PM
roadsterred wrote:
Is anyone surprised? The 50-year War on Poverty has created a new class of people in our society. It's called the Entitlement Class. This class expects everything for free and paid for by the government. Why work when you can stay at home, have kids and the government will support your lifestyle? When the War on Poverty was started in 1964 or thereabouts, the goal and objective was to cure poverty in 20 years. Instead of curing poverty, the War on Poverty has created generational poverty. Children born and raised in poverty are now married or unmarried and are having children raised in poverty. When will we admit that our safety net has accomplished just the opposite?
on January 17,2014 | 06:01PM
MightyMakiki wrote:
Here we go. The Pacific Islanders, the single payer Democrats: Quest for everyone. They are all going to run us into the poor hours You wait an see..
on January 17,2014 | 06:08PM
Ronin006 wrote:
The censors at the Star-Advertiser are apparently gone bananas. This comment was sent for approval. “Fraud, waste and abuse are obviously rampant in Hawaii’s Medicaid program, yet I do not recall reading or hearing about a single person being tried and convicted of such crimes. Perhaps that is wide fraud, waste and abuse is so widespread – no one gets prosecuted.” What did I say that triggered the comment being sent for approval?
on January 17,2014 | 06:28PM
Skyler wrote:
You can't even quote articles sometimes without triggering the 'comment sent for approval' nonsense.
on January 17,2014 | 06:57PM
sailfish1 wrote:
The DHS, like all other state and city departments, have too many incompetent people. Why do they need a new 95 million dollar eligibility system? Their people should have been verifying applicants' eligibility (including income) since day one.
on January 17,2014 | 09:22PM
sailfish1 wrote:
The DHS, like most state and city departments, are full of incompetent (ainokea) workers. They should have been checking applcants' eligibility since day 1. Why do they now need a new 95million dollar eligibility system?
on January 17,2014 | 09:26PM
sailfish1 wrote:
The DHS, like most state and city departments, are full of in*competent (ainokea) workers. They should have been checking applcants' eligibility since day 1. Why do they now need a new 95million dollar eligibility system?
on January 17,2014 | 09:27PM
RandolphW wrote:
The Censors at the SA could care less about fraud and waste in government at all levels, and would much rather censor comments than have some of the facts come to light, or rather, the extent of the problems being disclosed. I guess these comments hit too close to home.
on January 17,2014 | 10:37PM
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