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Medicaid Fraud

Attorney General needs more resources

About 550,000 West Virginians — nearly one-third of our state’s residents — rely on Medicaid to pay some or all of their health care expenses. Obviously, the potential for fraud is enormous.

For several years, state Attorney General Patrick Morrisey has been asking the Legislature to place his office in charge of investigating Medicaid fraud. The task has been handled by the Department of Health and Human Resources.

Finally, lawmakers decided this year to let Morrisey have a crack at it. The Medicaid fraud unit is to be transferred to the attorney general’s office Oct. 1.

It makes sense for Morrisey’s office, which already handles consumer and disability fraud, to assume responsibility for Medicaid misdeeds. As he noted to our reporter, the presence of an experienced staff in his office already will provide helpful synergies. And, he noted, he plans to hire additional investigators.

Any number of possibilities for fraud exist in the Medicaid program. One is clients who lie about health care problems. Another is providers who use tactics such as “upcoding” — billing Medicaid for services patients did not require — to skim money from the program.

West Virginia’s Medicaid program costs about $3.8 billion a year, with the federal government paying most of that. Still, fraud costs Mountain State taxpayers money — reducing resources available to help people who truly require assistance.

The vast majority of Medicaid providers are honest, dedicated to helping patients, not ripping off taxpayers. But even a tiny minority of bad apples can steal an enormous amount of money.

We wish Morrisey and his staff success in tracking down perpetrators of Medicaid fraud and bringing them to justice. Legislators, who will be watching closely, should not hesitate to grant the attorney general’s office more resources if results during the first year of Morrisey’s oversight seem to indicate they could be used productively.