Health Care

Attorney general: Dozens of KanCare abuse complaints went to email no one checked

Seniors struggle with KanCare Clearinghouse

Kansas made a number of changes since 2015 meant to make the Medicaid eligibility process more efficient. Advocates for the elderly say the state instead set up a maze that seniors are getting lost in.
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Kansas made a number of changes since 2015 meant to make the Medicaid eligibility process more efficient. Advocates for the elderly say the state instead set up a maze that seniors are getting lost in.

For more than a year, dozens of complaints about KanCare fraud, waste and abuse went to an email account no one was checking, according to a report released Monday by the Kansas Attorney General’s Office.

The Kansas Legislature voted in 2017 to move the long-vacant Medicaid Inspector General watchdog position out of the Kansas Department of Health and Environment to the attorney general’s office.

But the report, dated July 31, says that from Aug. 7, 2017, to Jan. 9, 2019, KanCare complaints continued to flow into a defunct health department email account that no one was monitoring. That left 209 emails unread, including 95 that alleged wrongdoing or sought information on how to report wrongdoing.

After reviewing the complaints against state data, the attorney general’s office determined that 42 of them contained “partially or wholly substantiated allegations of Medicaid or SCHIP fraud, waste, abuse or illegal acts” that weren’t addressed.

KanCare is the privatized program that administers Medicaid and the State Children’s Health Insurance Program, or SCHIP, within Kansas.

The KanCare inspector general is tasked with auditing the insurance companies that administer those programs, but also investigates over-billing by health care providers and fraud committed by individuals on Medicaid.

The attorney general’s report says the majority of the unread complaints were reports that a Medicaid beneficiary “was lying about his or her income, residency or household composition” to get Medicaid fraudulently.

The report says that 16 complaints involved people whose Medicaid eligibility had been terminated by the time the complaint was reviewed and 26 who were still on Medicaid.

“We will update this report with the outcome of those cases after KDHE completes its followup,” the report says.

Ashley Jones-Wisner, a spokeswoman for KDHE, said the department “has been collaborating closely with the OIG (office of inspector general) and we look forward to resolving the issues identified in the OIG’s recent report as quickly as possible.”

“KDHE staff will review each of the 42 complaints submitted to the inactive email account and ensure they undergo a complete and thorough review,” Jones-Wisner said via email. “We look forward to continuing to work with the OIG as we work to improve the health of all Kansans and ensure that this does not happen again.”

A spokesman for the attorney general’s office declined a request for an interview Monday, saying the report speaks for itself.

The report is the first from Sarah Fertig, an assistant attorney general who was appointed Medicaid inspector general last year and confirmed by the Kansas Senate in January after the position had been vacant almost five years.

“We’re excited that she’s getting to work and those things are getting covered now,” said Sean Gatewood of the KanCare Advocates Network, a coalition that represents people on KanCare. “It’s just sad that they weren’t for so long.”

Gov. Sam Brownback appointed former state representative Phil Hermanson to the job in 2014, but Hermanson resigned after just three months following news reports about a past DUI, bankruptcy and campaign finance violations.

Brownback and KDHE officials never replaced Hermanson, saying there were few qualified applicants interested in the $77,000-a-year state job and at times questioning whether a KanCare inspector general was necessary.

After a wave of Democrats and moderate Republicans were elected, the Legislature voted in 2017 to move the position to the Attorney General’s Office.

But according to the attorney general’s report, no one told the office about the email account because the inspector general’s office within KDHE “had been completely unstaffed since November 2014.”

“As a consequence, there were no incoming OIG staff to alert the Attorney General’s Office to the existence of the KDHE OIG email account or to notify KDHE that the kdhe.OIG@ks.gov address should be deactivated,” the report says.

An administrative employee in another division of KDHE monitored the email account until August 2017, but after that employee left, no one else took responsibility for it.

Sen. Barbara Bollier, a Democrat from Mission Hills who serves on a KanCare oversight committee, said the mix-up reflected a lack of leadership among Democratic Gov. Laura Kelly’s Republican predecessors.

“This is exactly why we need good government,” Bollier said, “and a governor who appropriately oversees Kansas.”

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Kansas City Star health reporter Andy Marso was part of a Pulitzer Prize-finalist team at The Star and previously won state and regional awards at the Topeka Capital-Journal and Kansas Health Institute News Service. He has written two books, including one about his near-fatal bout with meningitis.
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