Brock expects audit of Medicaid to yield savings

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(Host) State Auditor Randy Brock says he expects an audit of the state’s Medicaid program to yield savings for Vermonters.

Today Brock briefed a legislative committee on the state’s first-ever comprehensive examination of Medicaid. He says the review will look for improper payments fraud, waste and abuse in the health care program.

VPR’s John Dillon reports:

(Dillon) The Vermont Medicaid program costs roughly $939 million. About 60% of that comes from the federal government, but it’s the state’s responsibility to make sure that the money is spent properly.

Auditor Randy Brock told the Health Access Oversight committee that the state in the past has reported no problems with fraud and abuse. But Brock says the absence of any findings is itself a red flag, according to audits conducted by the Government Accountability Office.

(Brock) “We notice as we review these reports that they read zero, zero, zero, zero. We’re reporting and evidently finding little or nothing. And that’s in stark contrast to what we see in other states as well as what we’re told by the GAO of what it’s reasonable to expect. There’s a gap.”

(Dillon) Medicaid is the biggest single area of spending in state government, and serves about 25% of the state’s population. Brock says Medicaid audits in other states have found improper payments ranging from a low of 3 percent to a high of 13 percent.

(Brock) “And if you apply that to what we’re seeing here, those are absolutely enormous numbers.”

(Dillon) The auditor’s office will use income tax data to cross check whether people are eligible for Medicaid. But he says the review may also uncover cases in which a person is paying too much for health care under the program.

(Brock) “For example, do we have situations in which we have people whose income level is such that they should not have as high a co-pay as they do, but for one reason or another, are classified so they’re actually not getting benefits to which they are entitled. Some of the things we’re seeing in our raw data suggest this is an area we need to explore.”

(Dillon) Chittenden County Senator Ed Flanagan is a former state auditor and a member of the oversight committee. He listened to Brock’s presentation on speaker phone and challenged the auditor on the focus of his review.

(Flanagan) “I’m sorry, but I just didn’t hear any balance in emphasis between the goal of providing benefits to those who are truly eligible, a balance between that and between identifying money that the state is spending that we should not be spending.”

(Dillon) Brock replied that his main focus is on finding waste, fraud and abuse in the program.

The audit was launched in April, and Brock said he expects to have preliminary findings this fall.

For Vermont Public Radio, I’m John Dillon in Montpelier.

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