Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
I got to ask you about fraud, waste, and abuse.
My understanding is we're one of the worst states when
it comes to spending and a misspending, I'll call it
that generally in the program. Are you doing anything with
your committee to get to the bottom of that and
drill down maybe we can find some savings on the
money going out the door.
Speaker 2 (00:17):
We absolutely are. Our auditor Auditor Favor did an audit
on Medicaid last year and he found when he pulled
a sample of people on Medicaid that twenty six percent
of the sample that we were paying Medicaid costs for
don't live in Ohio.
Speaker 1 (00:32):
Oh my god.
Speaker 2 (00:34):
So when you find that kind of stuff, because we're
a state that has something called self addest station. So
I know you're an attorney, but what this means is
that if I go in and you say are you
on Medicaid? I can say, yep, Brian, I am, And
yet I live in Westchester, and you know I won't
say where I live and I live in a middle
class home. And if I say I have Medicaid, they
(00:56):
have to accept that. They don't confirm it. They don't
confirm my ad just they don't come from my income level,
none of it. So now we are what we have
to ask for waivers in some of these things. But
we're going to do regular cross checks because and that's
an answer to the auditor's audit. I mean, what more
do I need to say to you that our auditor
(01:17):
found this and what I found and it's taken me.
And this is why you know, term limits are not
what everybody thinks they are. It takes us a while
to figure all of this out and then in eight
years we're gone, but the bureaucrats stay, and so we
get into this huge spend because the bureaucrats keep spending.
Speaker 1 (01:38):
Obviously the ball is drought. Is anybody going to be
held accountable on this? I guess up. First off, I
need to understand about accountability on it, because we are
talking we are the worst state in the Union on this.
Our improper payment rate is reportedly double the national average,
and it's billions of dollars. I got to listen to
the calls in and likes to point out the amount
of fraud and waste, fraud and the medicaid system here
(01:58):
in Ohio could have paid for three Brent Sprends bridges
regardless of that is this not a at least conceptually
simple matter to fix.
Speaker 3 (02:09):
And that's exactly the right answer. The problem is is,
in fact, if we're going to continue to run a
eighty eight county system, you've got to have some accountability
in those eighty eight counties. I mean, the answer may
be to consolidate this back. I hate to say bigger
is better, but because in state government it never has
been true. But in this case, to require a state
(02:31):
system that those local job and family services offices actually
run down those alerts, you know, they send an alert.
In some cases the alerts can be you know, just
a pain in the butt because there are so many
of them, and in some cases the alerts don't mean much.
But the reality is the system is designed to trigger
on certain things, and if it triggers on that, there's
(02:53):
a reason to look at that person as a potential beneficiary.
And so what we found is upwards are twenty five
million dollars of people were receiving duplicate benefit eligibility in
multiple states. And that was just a snapshot. It wasn't
even a holistic across the board, every plane take a
look at it. The bigger problem was the first the
(03:14):
first audit we did in Medicaid that started identifying some
of these problems, and we found in that case literally
one hundred and twenty million dollars And this is extra
money that was kept by the managed care organizations where
they were literally being paid for claimants that were ineligible,
you know, people that were in our prisons, people in
the jails and other places. That is also a big problem,
(03:37):
and so I think the state needs to come back
in and take a look at these contracts and to
managed care people and do some plane recovery and go
back and try and get some of that money back.
And so we've really been trying to make a big
deal about that, and certainly this is the tip of
the iceberg. We are partnering with the Government Accountability Office
and other similar state auditors offices around the country to
(03:58):
get a national database. There is no reason that we
don't have a database to say, hey, Joe Smith is
getting claims in Indiana, rights in Ohio for Medicaid right
And in many cases it's really easy to track those
down because we've got their individual claim identifiers. I mean,
it's not like we can say, hey, yeah, there's a
(04:19):
lot of Joe Smith there are, but we know which
Joe Smith is using which account numbers, and so that
should be relatively easy from a database perspective to find
out where other claims are being made.
Speaker 1 (04:29):
It just rights to the level of criminal conduct. I mean,
if the local counties dropped the ball and not falling
through with these red flags that came up. The entities
that are responsible for paying and managing the claims that
you refer to these medical providers, I mean, can they
not be held accountable? Is there something by way? I
mean you have that as an option to call back
the money, right.
Speaker 3 (04:50):
Yeah, and certainly some of those cases that's the solution
is for them to look into it. But you know,
I hate to say this, but when we first alerted
to medicate the one hundred and twenty million dollar problem,
some of the reaction we got from their internal personnel was, yeah,
we get that that's a problem, but we really thought
the problem would even be bigger than that one hundred
twenty million dollars. Not that big a deal when you're
(05:11):
running a fifty billion dollar or forty billion dollar program,
remember Medicaid in Ohio. This is to put this in
perspective for your for your listeners. Medicaid in Ohio encompasses
darn near fifty cents on the dollar of state discretionary spending,
and so the state budget has something called general revenue
fund dollars. And when you look at the all the
(05:34):
funds that are spent in the state of Ohio, Medicaid,
meaning the healthcare system for the poor, is nearly fifty
cents on the dollar, and it's largely it's about sixty
percent federal dollars and about forty percent state dollars, give
or take. That ratio changes when the federal governments do
things like they did in the pandemic to sweepen the
reimbursement rate for the states so that we won't kick
(05:55):
more people off the Medicaid roles. But effectively, it's a
lot of money. And from that perspective, a little bit
of an error adds up really quickly to a lot
of money.
Speaker 1 (06:06):
To the billions.
Speaker 3 (06:07):
I mean, yeah, we are talking.
Speaker 1 (06:09):
About billions of billions of fraudulent payment here. I mean
every little bit counts, and this is obviously added up
very quickly. I guess I'm just like millions of questions
flowing through my head on this auditor favor what took
so long to identify this as even a problem. I
understand you. You're working on a solution. You're working on
(06:30):
trying to get some of the money back. Hopefully it'll stop.
But if it's fifty cents on the dollar, that figure
would be a lot lower if billions of dollars didn't
go out and fraudulent payments.
Speaker 3 (06:40):
Well, the short answer is, our job as auditor is
to dentify places when government doesn't work very well. It's
the job of the departments and the governor and the
legislature to find the solutions. We can make some recommendations
when something doesn't work well, things they need to fix,
but it's it's as the independent auditor. What we do
(07:01):
is go out and take a look at government. We
identify when people lie, steal and cheat in government, and
then we also make recommendations to make government work better, faster, cheaper.
We've now convicted our one hundred or were approaching conviction
our one hundredth government official who was lying, stealing and
cheating so far. I mean, certainly there is lie, cheating,
and stealing in these programs, but that isn't the source
(07:25):
of most of the money that's being lost unemployment, it
certainly was. That was a different scenario, But in medicaid,
what we're seeing is really it's just the system isn't
working like it should, and we've got bureaucrats for lack
of a better term, that frankly, have grown indifferent and
that has to get fixed. And that's what we really
(07:47):
push on the medicaid side. When the Department of Job
and Family Services people tell us they're shocked that the
number we find for waste frauden of use inside their
system isn't bigger, and it's one hundred and twenty million
dollars and they're like, oh, well, that's just kind of
a number, and we're really, that's unacceptable. One hundred and
twenty million dollars is literally, in many cases, the difference
(08:09):
between us having programs to help addict it or mentally
help ill or other programs in the state or not
I got to ask you about fraud, waste, and abuse.
My understanding is we're one of the worst states when
it comes to spending and a misspending, I'll call it
that generally in the program. Are you doing anything with
your committee to get to the bottom of that and
drill down maybe we can find some savings on the
money going out the door.
Speaker 2 (00:17):
We absolutely are. Our auditor Auditor Favor did an audit
on Medicaid last year and he found when he pulled
a sample of people on Medicaid that twenty six percent
of the sample that we were paying Medicaid costs for
don't live in Ohio.
Speaker 1 (00:32):
Oh my god.
Speaker 2 (00:34):
So when you find that kind of stuff, because we're
a state that has something called self addest station. So
I know you're an attorney, but what this means is
that if I go in and you say are you
on Medicaid? I can say, yep, Brian, I am, And
yet I live in Westchester, and you know I won't
say where I live and I live in a middle
class home. And if I say I have Medicaid, they
(00:56):
have to accept that. They don't confirm it. They don't
confirm my ad just they don't come from my income level,
none of it. So now we are what we have
to ask for waivers in some of these things. But
we're going to do regular cross checks because and that's
an answer to the auditor's audit. I mean, what more
do I need to say to you that our auditor
(01:17):
found this and what I found and it's taken me.
And this is why you know, term limits are not
what everybody thinks they are. It takes us a while
to figure all of this out and then in eight
years we're gone, but the bureaucrats stay, and so we
get into this huge spend because the bureaucrats keep spending.
Speaker 1 (01:38):
Obviously the ball is drought. Is anybody going to be
held accountable on this? I guess up. First off, I
need to understand about accountability on it, because we are
talking we are the worst state in the Union on this.
Our improper payment rate is reportedly double the national average,
and it's billions of dollars. I got to listen to
the calls in and likes to point out the amount
of fraud and waste, fraud and the medicaid system here
(01:58):
in Ohio could have paid for three Brent Sprends bridges
regardless of that is this not a at least conceptually
simple matter to fix.
Speaker 3 (02:09):
And that's exactly the right answer. The problem is is,
in fact, if we're going to continue to run a
eighty eight county system, you've got to have some accountability
in those eighty eight counties. I mean, the answer may
be to consolidate this back. I hate to say bigger
is better, but because in state government it never has
been true. But in this case, to require a state
(02:31):
system that those local job and family services offices actually
run down those alerts, you know, they send an alert.
In some cases the alerts can be you know, just
a pain in the butt because there are so many
of them, and in some cases the alerts don't mean much.
But the reality is the system is designed to trigger
on certain things, and if it triggers on that, there's
(02:53):
a reason to look at that person as a potential beneficiary.
And so what we found is upwards are twenty five
million dollars of people were receiving duplicate benefit eligibility in
multiple states. And that was just a snapshot. It wasn't
even a holistic across the board, every plane take a
look at it. The bigger problem was the first the
(03:14):
first audit we did in Medicaid that started identifying some
of these problems, and we found in that case literally
one hundred and twenty million dollars And this is extra
money that was kept by the managed care organizations where
they were literally being paid for claimants that were ineligible,
you know, people that were in our prisons, people in
the jails and other places. That is also a big problem,
(03:37):
and so I think the state needs to come back
in and take a look at these contracts and to
managed care people and do some plane recovery and go
back and try and get some of that money back.
And so we've really been trying to make a big
deal about that, and certainly this is the tip of
the iceberg. We are partnering with the Government Accountability Office
and other similar state auditors offices around the country to
(03:58):
get a national database. There is no reason that we
don't have a database to say, hey, Joe Smith is
getting claims in Indiana, rights in Ohio for Medicaid right
And in many cases it's really easy to track those
down because we've got their individual claim identifiers. I mean,
it's not like we can say, hey, yeah, there's a
(04:19):
lot of Joe Smith there are, but we know which
Joe Smith is using which account numbers, and so that
should be relatively easy from a database perspective to find
out where other claims are being made.
Speaker 1 (04:29):
It just rights to the level of criminal conduct. I mean,
if the local counties dropped the ball and not falling
through with these red flags that came up. The entities
that are responsible for paying and managing the claims that
you refer to these medical providers, I mean, can they
not be held accountable? Is there something by way? I
mean you have that as an option to call back
the money, right.
Speaker 3 (04:50):
Yeah, and certainly some of those cases that's the solution
is for them to look into it. But you know,
I hate to say this, but when we first alerted
to medicate the one hundred and twenty million dollar problem,
some of the reaction we got from their internal personnel was, yeah,
we get that that's a problem, but we really thought
the problem would even be bigger than that one hundred
twenty million dollars. Not that big a deal when you're
(05:11):
running a fifty billion dollar or forty billion dollar program,
remember Medicaid in Ohio. This is to put this in
perspective for your for your listeners. Medicaid in Ohio encompasses
darn near fifty cents on the dollar of state discretionary spending,
and so the state budget has something called general revenue
fund dollars. And when you look at the all the
(05:34):
funds that are spent in the state of Ohio, Medicaid,
meaning the healthcare system for the poor, is nearly fifty
cents on the dollar, and it's largely it's about sixty
percent federal dollars and about forty percent state dollars, give
or take. That ratio changes when the federal governments do
things like they did in the pandemic to sweepen the
reimbursement rate for the states so that we won't kick
(05:55):
more people off the Medicaid roles. But effectively, it's a
lot of money. And from that perspective, a little bit
of an error adds up really quickly to a lot
of money.
Speaker 1 (06:06):
To the billions.
Speaker 3 (06:07):
I mean, yeah, we are talking.
Speaker 1 (06:09):
About billions of billions of fraudulent payment here. I mean
every little bit counts, and this is obviously added up
very quickly. I guess I'm just like millions of questions
flowing through my head on this auditor favor what took
so long to identify this as even a problem. I
understand you. You're working on a solution. You're working on
(06:30):
trying to get some of the money back. Hopefully it'll stop.
But if it's fifty cents on the dollar, that figure
would be a lot lower if billions of dollars didn't
go out and fraudulent payments.
Speaker 3 (06:40):
Well, the short answer is, our job as auditor is
to dentify places when government doesn't work very well. It's
the job of the departments and the governor and the
legislature to find the solutions. We can make some recommendations
when something doesn't work well, things they need to fix,
but it's it's as the independent auditor. What we do
(07:01):
is go out and take a look at government. We
identify when people lie, steal and cheat in government, and
then we also make recommendations to make government work better, faster, cheaper.
We've now convicted our one hundred or were approaching conviction
our one hundredth government official who was lying, stealing and
cheating so far. I mean, certainly there is lie, cheating,
and stealing in these programs, but that isn't the source
(07:25):
of most of the money that's being lost unemployment, it
certainly was. That was a different scenario, But in medicaid,
what we're seeing is really it's just the system isn't
working like it should, and we've got bureaucrats for lack
of a better term, that frankly, have grown indifferent and
that has to get fixed. And that's what we really
(07:47):
push on the medicaid side. When the Department of Job
and Family Services people tell us they're shocked that the
number we find for waste frauden of use inside their
system isn't bigger, and it's one hundred and twenty million
dollars and they're like, oh, well, that's just kind of
a number, and we're really, that's unacceptable. One hundred and
twenty million dollars is literally, in many cases, the difference
(08:09):
between us having programs to help addict it or mentally
help ill or other programs in the state or not
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