Speaker 1: I got to ask you about fraud, waste, and abuse.
Speaker 1: My understanding is we're one of the worst states when
Speaker 1: it comes to spending and a misspending, I'll call it
Speaker 1: that generally in the program. Are you doing anything with
Speaker 1: your committee to get to the bottom of that and
Speaker 1: drill down maybe we can find some savings on the
Speaker 1: money going out the door.
Speaker 2: We absolutely are. Our auditor Auditor Favor did an audit
Speaker 2: on Medicaid last year and he found when he pulled
Speaker 2: a sample of people on Medicaid that twenty six percent
Speaker 2: of the sample that we were paying Medicaid costs for
Speaker 2: don't live in Ohio.
Speaker 1: Oh my god.
Speaker 2: So when you find that kind of stuff, because we're
Speaker 2: a state that has something called self addest station. So
Speaker 2: I know you're an attorney, but what this means is
Speaker 2: that if I go in and you say are you
Speaker 2: on Medicaid? I can say, yep, Brian, I am, And
Speaker 2: yet I live in Westchester, and you know I won't
Speaker 2: say where I live and I live in a middle
Speaker 2: class home. And if I say I have Medicaid, they
Speaker 2: have to accept that. They don't confirm it. They don't
Speaker 2: confirm my ad just they don't come from my income level,
Speaker 2: none of it. So now we are what we have
Speaker 2: to ask for waivers in some of these things. But
Speaker 2: we're going to do regular cross checks because and that's
Speaker 2: an answer to the auditor's audit. I mean, what more
Speaker 2: do I need to say to you that our auditor
Speaker 2: found this and what I found and it's taken me.
Speaker 2: And this is why you know, term limits are not
Speaker 2: what everybody thinks they are. It takes us a while
Speaker 2: to figure all of this out and then in eight
Speaker 2: years we're gone, but the bureaucrats stay, and so we
Speaker 2: get into this huge spend because the bureaucrats keep spending.
Speaker 1: Obviously the ball is drought. Is anybody going to be
Speaker 1: held accountable on this? I guess up. First off, I
Speaker 1: need to understand about accountability on it, because we are
Speaker 1: talking we are the worst state in the Union on this.
Speaker 1: Our improper payment rate is reportedly double the national average,
Speaker 1: and it's billions of dollars. I got to listen to
Speaker 1: the calls in and likes to point out the amount
Speaker 1: of fraud and waste, fraud and the medicaid system here
Speaker 1: in Ohio could have paid for three Brent Sprends bridges
Speaker 1: regardless of that is this not a at least conceptually
Speaker 1: simple matter to fix.
Speaker 3: And that's exactly the right answer. The problem is is,
Speaker 3: in fact, if we're going to continue to run a
Speaker 3: eighty eight county system, you've got to have some accountability
Speaker 3: in those eighty eight counties. I mean, the answer may
Speaker 3: be to consolidate this back. I hate to say bigger
Speaker 3: is better, but because in state government it never has
Speaker 3: been true. But in this case, to require a state
Speaker 3: system that those local job and family services offices actually
Speaker 3: run down those alerts, you know, they send an alert.
Speaker 3: In some cases the alerts can be you know, just
Speaker 3: a pain in the butt because there are so many
Speaker 3: of them, and in some cases the alerts don't mean much.
Speaker 3: But the reality is the system is designed to trigger
Speaker 3: on certain things, and if it triggers on that, there's
Speaker 3: a reason to look at that person as a potential beneficiary.
Speaker 3: And so what we found is upwards are twenty five
Speaker 3: million dollars of people were receiving duplicate benefit eligibility in
Speaker 3: multiple states. And that was just a snapshot. It wasn't
Speaker 3: even a holistic across the board, every plane take a
Speaker 3: look at it. The bigger problem was the first the
Speaker 3: first audit we did in Medicaid that started identifying some
Speaker 3: of these problems, and we found in that case literally
Speaker 3: one hundred and twenty million dollars And this is extra
Speaker 3: money that was kept by the managed care organizations where
Speaker 3: they were literally being paid for claimants that were ineligible,
Speaker 3: you know, people that were in our prisons, people in
Speaker 3: the jails and other places. That is also a big problem,
Speaker 3: and so I think the state needs to come back
Speaker 3: in and take a look at these contracts and to
Speaker 3: managed care people and do some plane recovery and go
Speaker 3: back and try and get some of that money back.
Speaker 3: And so we've really been trying to make a big
Speaker 3: deal about that, and certainly this is the tip of
Speaker 3: the iceberg. We are partnering with the Government Accountability Office
Speaker 3: and other similar state auditors offices around the country to
Speaker 3: get a national database. There is no reason that we
Speaker 3: don't have a database to say, hey, Joe Smith is
Speaker 3: getting claims in Indiana, rights in Ohio for Medicaid right
Speaker 3: And in many cases it's really easy to track those
Speaker 3: down because we've got their individual claim identifiers. I mean,
Speaker 3: it's not like we can say, hey, yeah, there's a
Speaker 3: lot of Joe Smith there are, but we know which
Speaker 3: Joe Smith is using which account numbers, and so that
Speaker 3: should be relatively easy from a database perspective to find
Speaker 3: out where other claims are being made.
Speaker 1: It just rights to the level of criminal conduct. I mean,
Speaker 1: if the local counties dropped the ball and not falling
Speaker 1: through with these red flags that came up. The entities
Speaker 1: that are responsible for paying and managing the claims that
Speaker 1: you refer to these medical providers, I mean, can they
Speaker 1: not be held accountable? Is there something by way? I
Speaker 1: mean you have that as an option to call back
Speaker 1: the money, right.
Speaker 3: Yeah, and certainly some of those cases that's the solution
Speaker 3: is for them to look into it. But you know,
Speaker 3: I hate to say this, but when we first alerted
Speaker 3: to medicate the one hundred and twenty million dollar problem,
Speaker 3: some of the reaction we got from their internal personnel was, yeah,
Speaker 3: we get that that's a problem, but we really thought
Speaker 3: the problem would even be bigger than that one hundred
Speaker 3: twenty million dollars. Not that big a deal when you're
Speaker 3: running a fifty billion dollar or forty billion dollar program,
Speaker 3: remember Medicaid in Ohio. This is to put this in
Speaker 3: perspective for your for your listeners. Medicaid in Ohio encompasses
Speaker 3: darn near fifty cents on the dollar of state discretionary spending,
Speaker 3: and so the state budget has something called general revenue
Speaker 3: fund dollars. And when you look at the all the
Speaker 3: funds that are spent in the state of Ohio, Medicaid,
Speaker 3: meaning the healthcare system for the poor, is nearly fifty
Speaker 3: cents on the dollar, and it's largely it's about sixty
Speaker 3: percent federal dollars and about forty percent state dollars, give
Speaker 3: or take. That ratio changes when the federal governments do
Speaker 3: things like they did in the pandemic to sweepen the
Speaker 3: reimbursement rate for the states so that we won't kick
Speaker 3: more people off the Medicaid roles. But effectively, it's a
Speaker 3: lot of money. And from that perspective, a little bit
Speaker 3: of an error adds up really quickly to a lot
Speaker 3: of money.
Speaker 1: To the billions.
Speaker 3: I mean, yeah, we are talking.
Speaker 1: About billions of billions of fraudulent payment here. I mean
Speaker 1: every little bit counts, and this is obviously added up
Speaker 1: very quickly. I guess I'm just like millions of questions
Speaker 1: flowing through my head on this auditor favor what took
Speaker 1: so long to identify this as even a problem. I
Speaker 1: understand you. You're working on a solution. You're working on
Speaker 1: trying to get some of the money back. Hopefully it'll stop.
Speaker 1: But if it's fifty cents on the dollar, that figure
Speaker 1: would be a lot lower if billions of dollars didn't
Speaker 1: go out and fraudulent payments.
Speaker 3: Well, the short answer is, our job as auditor is
Speaker 3: to dentify places when government doesn't work very well. It's
Speaker 3: the job of the departments and the governor and the
Speaker 3: legislature to find the solutions. We can make some recommendations
Speaker 3: when something doesn't work well, things they need to fix,
Speaker 3: but it's it's as the independent auditor. What we do
Speaker 3: is go out and take a look at government. We
Speaker 3: identify when people lie, steal and cheat in government, and
Speaker 3: then we also make recommendations to make government work better, faster, cheaper.
Speaker 3: We've now convicted our one hundred or were approaching conviction
Speaker 3: our one hundredth government official who was lying, stealing and
Speaker 3: cheating so far. I mean, certainly there is lie, cheating,
Speaker 3: and stealing in these programs, but that isn't the source
Speaker 3: of most of the money that's being lost unemployment, it
Speaker 3: certainly was. That was a different scenario, But in medicaid,
Speaker 3: what we're seeing is really it's just the system isn't
Speaker 3: working like it should, and we've got bureaucrats for lack
Speaker 3: of a better term, that frankly, have grown indifferent and
Speaker 3: that has to get fixed. And that's what we really
Speaker 3: push on the medicaid side. When the Department of Job
Speaker 3: and Family Services people tell us they're shocked that the
Speaker 3: number we find for waste frauden of use inside their
Speaker 3: system isn't bigger, and it's one hundred and twenty million
Speaker 3: dollars and they're like, oh, well, that's just kind of
Speaker 3: a number, and we're really, that's unacceptable. One hundred and
Speaker 3: twenty million dollars is literally, in many cases, the difference
Speaker 3: between us having programs to help addict it or mentally
Speaker 3: help ill or other programs in the state or not