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<v Speaker 1>I got to ask you about fraud, waste, and abuse.

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<v Speaker 1>My understanding is we're one of the worst states when

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<v Speaker 1>it comes to spending and a misspending, I'll call it

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<v Speaker 1>that generally in the program. Are you doing anything with

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<v Speaker 1>your committee to get to the bottom of that and

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<v Speaker 1>drill down maybe we can find some savings on the

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<v Speaker 1>money going out the door.

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<v Speaker 2>We absolutely are. Our auditor Auditor Favor did an audit

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<v Speaker 2>on Medicaid last year and he found when he pulled

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<v Speaker 2>a sample of people on Medicaid that twenty six percent

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<v Speaker 2>of the sample that we were paying Medicaid costs for

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<v Speaker 2>don't live in Ohio.

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<v Speaker 1>Oh my god.

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<v Speaker 2>So when you find that kind of stuff, because we're

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<v Speaker 2>a state that has something called self addest station. So

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<v Speaker 2>I know you're an attorney, but what this means is

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<v Speaker 2>that if I go in and you say are you

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<v Speaker 2>on Medicaid? I can say, yep, Brian, I am, And

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<v Speaker 2>yet I live in Westchester, and you know I won't

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<v Speaker 2>say where I live and I live in a middle

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<v Speaker 2>class home. And if I say I have Medicaid, they

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<v Speaker 2>have to accept that. They don't confirm it. They don't

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<v Speaker 2>confirm my ad just they don't come from my income level,

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<v Speaker 2>none of it. So now we are what we have

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<v Speaker 2>to ask for waivers in some of these things. But

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<v Speaker 2>we're going to do regular cross checks because and that's

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<v Speaker 2>an answer to the auditor's audit. I mean, what more

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<v Speaker 2>do I need to say to you that our auditor

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<v Speaker 2>found this and what I found and it's taken me.

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<v Speaker 2>And this is why you know, term limits are not

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<v Speaker 2>what everybody thinks they are. It takes us a while

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<v Speaker 2>to figure all of this out and then in eight

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<v Speaker 2>years we're gone, but the bureaucrats stay, and so we

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<v Speaker 2>get into this huge spend because the bureaucrats keep spending.

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<v Speaker 1>Obviously the ball is drought. Is anybody going to be

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<v Speaker 1>held accountable on this? I guess up. First off, I

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<v Speaker 1>need to understand about accountability on it, because we are

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<v Speaker 1>talking we are the worst state in the Union on this.

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<v Speaker 1>Our improper payment rate is reportedly double the national average,

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<v Speaker 1>and it's billions of dollars. I got to listen to

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<v Speaker 1>the calls in and likes to point out the amount

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<v Speaker 1>of fraud and waste, fraud and the medicaid system here

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<v Speaker 1>in Ohio could have paid for three Brent Sprends bridges

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<v Speaker 1>regardless of that is this not a at least conceptually

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<v Speaker 1>simple matter to fix.

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<v Speaker 3>And that's exactly the right answer. The problem is is,

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<v Speaker 3>in fact, if we're going to continue to run a

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<v Speaker 3>eighty eight county system, you've got to have some accountability

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<v Speaker 3>in those eighty eight counties. I mean, the answer may

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<v Speaker 3>be to consolidate this back. I hate to say bigger

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<v Speaker 3>is better, but because in state government it never has

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<v Speaker 3>been true. But in this case, to require a state

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<v Speaker 3>system that those local job and family services offices actually

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<v Speaker 3>run down those alerts, you know, they send an alert.

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<v Speaker 3>In some cases the alerts can be you know, just

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<v Speaker 3>a pain in the butt because there are so many

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<v Speaker 3>of them, and in some cases the alerts don't mean much.

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<v Speaker 3>But the reality is the system is designed to trigger

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<v Speaker 3>on certain things, and if it triggers on that, there's

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<v Speaker 3>a reason to look at that person as a potential beneficiary.

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<v Speaker 3>And so what we found is upwards are twenty five

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<v Speaker 3>million dollars of people were receiving duplicate benefit eligibility in

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<v Speaker 3>multiple states. And that was just a snapshot. It wasn't

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<v Speaker 3>even a holistic across the board, every plane take a

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<v Speaker 3>look at it. The bigger problem was the first the

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<v Speaker 3>first audit we did in Medicaid that started identifying some

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<v Speaker 3>of these problems, and we found in that case literally

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<v Speaker 3>one hundred and twenty million dollars And this is extra

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<v Speaker 3>money that was kept by the managed care organizations where

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<v Speaker 3>they were literally being paid for claimants that were ineligible,

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<v Speaker 3>you know, people that were in our prisons, people in

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<v Speaker 3>the jails and other places. That is also a big problem,

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<v Speaker 3>and so I think the state needs to come back

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<v Speaker 3>in and take a look at these contracts and to

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<v Speaker 3>managed care people and do some plane recovery and go

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<v Speaker 3>back and try and get some of that money back.

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<v Speaker 3>And so we've really been trying to make a big

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<v Speaker 3>deal about that, and certainly this is the tip of

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<v Speaker 3>the iceberg. We are partnering with the Government Accountability Office

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<v Speaker 3>and other similar state auditors offices around the country to

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<v Speaker 3>get a national database. There is no reason that we

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<v Speaker 3>don't have a database to say, hey, Joe Smith is

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<v Speaker 3>getting claims in Indiana, rights in Ohio for Medicaid right

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<v Speaker 3>And in many cases it's really easy to track those

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<v Speaker 3>down because we've got their individual claim identifiers. I mean,

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<v Speaker 3>it's not like we can say, hey, yeah, there's a

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<v Speaker 3>lot of Joe Smith there are, but we know which

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<v Speaker 3>Joe Smith is using which account numbers, and so that

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<v Speaker 3>should be relatively easy from a database perspective to find

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<v Speaker 3>out where other claims are being made.

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<v Speaker 1>It just rights to the level of criminal conduct. I mean,

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<v Speaker 1>if the local counties dropped the ball and not falling

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<v Speaker 1>through with these red flags that came up. The entities

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<v Speaker 1>that are responsible for paying and managing the claims that

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<v Speaker 1>you refer to these medical providers, I mean, can they

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<v Speaker 1>not be held accountable? Is there something by way? I

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<v Speaker 1>mean you have that as an option to call back

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<v Speaker 1>the money, right.

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<v Speaker 3>Yeah, and certainly some of those cases that's the solution

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<v Speaker 3>is for them to look into it. But you know,

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<v Speaker 3>I hate to say this, but when we first alerted

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<v Speaker 3>to medicate the one hundred and twenty million dollar problem,

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<v Speaker 3>some of the reaction we got from their internal personnel was, yeah,

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<v Speaker 3>we get that that's a problem, but we really thought

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<v Speaker 3>the problem would even be bigger than that one hundred

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<v Speaker 3>twenty million dollars. Not that big a deal when you're

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<v Speaker 3>running a fifty billion dollar or forty billion dollar program,

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<v Speaker 3>remember Medicaid in Ohio. This is to put this in

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<v Speaker 3>perspective for your for your listeners. Medicaid in Ohio encompasses

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<v Speaker 3>darn near fifty cents on the dollar of state discretionary spending,

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<v Speaker 3>and so the state budget has something called general revenue

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<v Speaker 3>fund dollars. And when you look at the all the

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<v Speaker 3>funds that are spent in the state of Ohio, Medicaid,

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<v Speaker 3>meaning the healthcare system for the poor, is nearly fifty

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<v Speaker 3>cents on the dollar, and it's largely it's about sixty

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<v Speaker 3>percent federal dollars and about forty percent state dollars, give

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<v Speaker 3>or take. That ratio changes when the federal governments do

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<v Speaker 3>things like they did in the pandemic to sweepen the

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<v Speaker 3>reimbursement rate for the states so that we won't kick

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<v Speaker 3>more people off the Medicaid roles. But effectively, it's a

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<v Speaker 3>lot of money. And from that perspective, a little bit

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<v Speaker 3>of an error adds up really quickly to a lot

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<v Speaker 3>of money.

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<v Speaker 1>To the billions.

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<v Speaker 3>I mean, yeah, we are talking.

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<v Speaker 1>About billions of billions of fraudulent payment here. I mean

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<v Speaker 1>every little bit counts, and this is obviously added up

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<v Speaker 1>very quickly. I guess I'm just like millions of questions

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<v Speaker 1>flowing through my head on this auditor favor what took

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<v Speaker 1>so long to identify this as even a problem. I

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<v Speaker 1>understand you. You're working on a solution. You're working on

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<v Speaker 1>trying to get some of the money back. Hopefully it'll stop.

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<v Speaker 1>But if it's fifty cents on the dollar, that figure

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<v Speaker 1>would be a lot lower if billions of dollars didn't

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<v Speaker 1>go out and fraudulent payments.

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<v Speaker 3>Well, the short answer is, our job as auditor is

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<v Speaker 3>to dentify places when government doesn't work very well. It's

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<v Speaker 3>the job of the departments and the governor and the

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<v Speaker 3>legislature to find the solutions. We can make some recommendations

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<v Speaker 3>when something doesn't work well, things they need to fix,

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<v Speaker 3>but it's it's as the independent auditor. What we do

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<v Speaker 3>is go out and take a look at government. We

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<v Speaker 3>identify when people lie, steal and cheat in government, and

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<v Speaker 3>then we also make recommendations to make government work better, faster, cheaper.

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<v Speaker 3>We've now convicted our one hundred or were approaching conviction

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<v Speaker 3>our one hundredth government official who was lying, stealing and

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<v Speaker 3>cheating so far. I mean, certainly there is lie, cheating,

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<v Speaker 3>and stealing in these programs, but that isn't the source

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<v Speaker 3>of most of the money that's being lost unemployment, it

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<v Speaker 3>certainly was. That was a different scenario, But in medicaid,

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<v Speaker 3>what we're seeing is really it's just the system isn't

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<v Speaker 3>working like it should, and we've got bureaucrats for lack

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<v Speaker 3>of a better term, that frankly, have grown indifferent and

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<v Speaker 3>that has to get fixed. And that's what we really

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<v Speaker 3>push on the medicaid side. When the Department of Job

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<v Speaker 3>and Family Services people tell us they're shocked that the

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<v Speaker 3>number we find for waste frauden of use inside their

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<v Speaker 3>system isn't bigger, and it's one hundred and twenty million

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<v Speaker 3>dollars and they're like, oh, well, that's just kind of

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<v Speaker 3>a number, and we're really, that's unacceptable. One hundred and

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<v Speaker 3>twenty million dollars is literally, in many cases, the difference

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<v Speaker 3>between us having programs to help addict it or mentally

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<v Speaker 3>help ill or other programs in the state or not