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State Auditor report reveals potential fraudulent Medicaid claims

State Auditor Shad White. Photo by News Mississippi

A report from the State Auditor’s Office has revealed potential fraudulent Medicaid claims in Mississippi. 

State Auditor Shad White revealed the findings of a yearly audit that examines the federal funds flowing through Mississippi state agencies—including the Mississippi Division of Medicaid. According to White, the audit sampled 180 Medicaid beneficiaries and found that potentially 5% were ineligible due to their high income reported on their tax return. Medicaid represents 49% of the federal funds spent by the state of Mississippi.

“The use of these returns to figure out if people are lying to obtain benefits started last year in my office,” White said. “We now have enough data to show there are millions of dollars of potential savings if we can prevent ineligible people from getting on Medicaid. The benefits should only be going to those who deserve to be on the program.”

Auditors spotted the potential fraud by comparing the income that Medicaid recipients reported to Medicaid with their state income tax returns. White detailed two cases in which individuals, who own multi-million dollar homes, declared high incomes on their most recent tax returns but also received Medicaid benefits. Medicaid had already identified the individuals as potential fraud cases to investigate.

Under current law, White stated that the Division of Medicaid does not have the legal authority to obtain state income tax returns to compare to the income claimed by Medicaid applicants when they apply for the program.

“Under current law, Medicaid cannot do the analysis we did here,” White said. “I stand ready to work with Medicaid’s leadership to argue to lawmakers that they should have this tool in their toolbox. It could stop ineligible applicants from being put on the program in the first place. We know this tool would be useful because Medicaid’s internal policies state they should ask an applicant for their return, but without the authority to get the return and a requirement to use it, the state is potentially handing out millions to ineligible people.”

The full audit report can be found online at the Auditor’s website.

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