During the Office of the Inspector General’s first four years of existence, fraud detection efforts in public assistance programs resulted in millions of dollars in savings for Wisconsin.
Gov. Scott Walker, who created the program in 2011, said in a statement the goal of the OIG is to make sure government services are not abused.
“The Office of the Inspector General focuses on detecting fraud in programs like Medicaid, FoodShare and BadgerCare Plus, and the work OIG has done thus far, on behalf of the taxpayers of this state, is remarkable,” Walker said. “Eliminating fraud helps guarantee these services are available for those who really need them.”
Fraud detection efforts resulted in an 80 percent increase in savings for the state from $14.6 million in 2012 to $26.5 million in 2015, according to the OIG’s first report.
In the past four years, OIG also identified $50 million and recovered $40 million in overpayments to Medicaid providers, according to the report. The OIG collected nearly $90 million in drug settlements.
OIG increased monitoring and detecting of fraud within the FoodShare program, the report said, resulting in 1,300 individuals suspended from FoodShare for rule violations in 2015, compared to only 200 suspensions in 2012.
Fraud that occurs with food stamps is not usually what people think it is, Pamela Herd, University of Wisconsin public affairs professor and expert on social welfare policies, said. She said most fraud in the FoodShare program occurs because of application mistakes.
“People … getting confused and making some erroneous mistake on an application will get calculated as fraud and abuse,” Herd said.
Herd added she has not seen or heard anything about unusually high rates of fraud and abuse in Wisconsin.
For Medicaid abuse, Herd said, most occurs on the provider side of things, rather than the consumer side. Some hospitals have conducted “sham operations” claiming they had patients who did not exist so they could collect money from Medicaid or other public health assistance programs.
According to the report, OIG discovered 11 providers who were submitting claims to Medicaid for orthotics, but the patients didn’t need them and never actually received them. The health care providers were prosecuted and ordered to pay restitution of more than $1.5 million.
It is hard for consumers to actually commit Medicaid fraud, Herd said. Sometimes older adults will transfer some of their assets to their children to try to qualify for Medicaid, but it is hard to avoid getting caught because the litigation is so complicated, she said.
While Herd said she doesn’t know enough about the OIG to comment on its quality, she said she does not understand why the organization was created in the first place because the Legislature already investigates fraud.
“The Legislative Audit Bureau and Legislative Fiscal Bureau have consistently been very good … about this kind of thing,” Herd said. “I don’t know why you would create a separate group to do this … when you have already within the legislative branch … some of the best policy analysts in the country.”
The OIG was created to consolidate existing investigation staff and add additional resources, according to the report. The main priority of the OIG is to protect taxpayer dollars and keep public assistance programs sustainable long term.
