A state pilot program to ferret out Medicaid fraud and abuse found about $11 million in potentially illegal charges over the past three and a half years.
Contractor Health Integrity’s report shows potentially inappropriate claims paid out in several areas shared between federal and state government.
Potentially fraudulent dental charges made up the largest share of projected refunds at $3.2 million. The report says dentists could’ve billed for medically unnecessary procedures or charged for services they didn’t perform.
Others include paying for ineligible patients’ hospice care and hospitals charging inpatient rates for outpatient care.
Most of those claims need to be reviewed further to be proven fraudulent.
A test run of the pilot program in the spring tallied $4.1 million in potential abuse.
Health Integrity earned $250,000 for the contract, with another $250,000 available if the state recoups any savings.
