It is unclear how much Medicaid recipient fraud is present in Iowa.
Other states have found:
- Deceaced enrollees
- Large dollar lottery winners
- Multi-state recipients
- A high percentage no longer qualify
- Regularly review recipient eligibility.
- Remove individuals from the rolls who abuse the system.
Work Left to Do:
Inform legislators that allowing Medicaid fraud doesn’t just fleece the taxpayer; it is unfair to those Iowans who genuinely need the services Medicaid provides.
Every dollar lost to waste, fraud, or abuse is a dollar that cannot go to fund services for those with genuine and urgent needs.
Abuse and fraud within Medicaid is a serious and costly issue. Jonathan Ingram, Vice President of Research at the Foundation for Government Accountability (FGA), has written that “Medicaid fraud weighs heavy on budgets — both state and federal — and robs important resources from the truly needy. Every dollar lost to waste, fraud, or abuse is a dollar that cannot go to fund services for those with genuine and urgent needs.”
A Medicaid audit that regularly reviews recipient eligibility is a needed mechanism to ensure that benefits go to those Iowans who truly need the services. States that have begun the process of examining Medicaid eligibility abuse have found shocking results that are costing taxpayers millions. FGA previously outlined some of the findings of Medicaid eligibility abuse from other states:
- Michigan identified more than 7,000 lottery winners still collecting welfare, some with jackpots as high as $4 million.
- Illinois uncovered more than 14,000 dead enrollees still on Medicaid.
- Arkansas removed 25,000 individuals from their Medicaid rolls because they were receiving benefits in multiple states.
In Louisiana, the legislative auditor made a random selection of 100 Medicaid recipients and found that 82 of those individuals did not qualify to receive benefits. At this time, it is unclear how much Medicaid fraud is present in Iowa, but the evidence from other states demonstrates that a Medicaid recipient audit is needed.
Iowa’s Medicaid program has expanded due to the Patient Protection and Affordable Care Act and now nearly one in five Iowans receive Medicaid benefits. While the federal government picks up most of the tab, Medicaid is still the second largest appropriation within Iowa’s General Fund, totaling $1.4 billion in our state’s most recent budget. With this much money involved in delivering such needed care, Iowa taxpayers deserve to know that their hard-earned dollars are being spent appropriately.
A commonsense solution to halt Medicaid abuse should start with regular eligibility reviews of Medicaid recipients. These reviews should include:
- Earned and unearned income
- Residency status
- Death records
- Lottery winnings
- Other status changes that would otherwise make a recipient ineligible for assistance
Allowing Medicaid fraud and abuse doesn’t just fleece the taxpayer, but it is unfair to those Iowans who need the services Medicaid provides.