Investigative Reporter Jack Windsor - Ohio Medicaid Fraud and The Ohio Budget

Episode Transcript

Speaker 1 (00:00):
Hey, is Brian Thomas please to welcome to the fifty

(00:01):
five KSE Morning show. Jack Windsor, who's editor in chief
the Ohio Press Network, host of The Windsor Report, and
a bit of an investigative reporter, and he's going to
join me to offer and you his expertise on medicaid
fraud as well as the Ohio budget. Let's dive on
into medicate fraud. Apparently there is a ton of it
going on here in the state of Ohio, to the

(00:21):
tune of billions of dollars. I mean, we talk about
budgeting and short, oh, we don't have enough funds to
do this except for giving six hundred million dollars to
the Browns. But we don't have somebody for this project
or that project. But if they would just crack down
on fraud, waste and abuse, it would free up literally
billions of dollars. What is the current figure they estimate
right now? Jack Windsor, welcome to the show.

Speaker 2 (00:42):
Well, Brian, first of all, thank you for having me.
It's an honor to be here. And State Representative Mike
Devilla started a probe into Ohio's medicaid system and what
he found within one beneficiary population segment known as the
aged blind and disabled. If you were to extrapolate that
number out to the whole system, we're talking upwards of
six billion.

Speaker 1 (01:01):
Dollars Brian, six billion dollars with a bee, yep, billion
with a bee.

Speaker 2 (01:08):
And here's how he did it. If you don't mind,
I'll dive into that real quick.

Speaker 1 (01:12):
Please.

Speaker 2 (01:13):
Yeah. He started this probe back in April, and what
he said was give me records from twenty twenty three.
And when I asked him about that, he said, because
twenty twenty three's calendar year, all of that information should
be finalized, audited. I didn't want to look at twenty
twenty four because we're so early yet in twenty twenty five,
I didn't want any excuses. I wanted to know a
full year where you know, everything should be there for us.

(01:33):
So he started auditing, and he talked with the Hot
department in Medicaid and of course their third party vendors.
One of their third party vendors as a company and
many of us has probably heard of, called Lexus Nexus.
He found that in twenty twenty three, they reported that
twenty nine percent of that ABD, that aged blind and
disabled Medicaid Beneficiary group. Those folks may have been ineligible

(01:54):
and you go, okay, well what does that mean. That
means that they had assets well above the threshold that
would qualify them for Medicaid. And I always remind people
there's Medicare and Medicaid. Medicaid is for people who, in
my mind, we think don't have a lot of assets,
don't have a lot of resources, and they need some assistance.
And we're not just talking a little bit, Brian. There
were over four thousand people who had assets between one

(02:17):
hundred thousand and nine hundred thousand. There were twelve people
that had assets over a million dollars on Ohio's Medicaid
payment system. And that really was what Devilla's appetite, and
he said, Okay, we've really got to start diving into this,
and we published the first story at the Ohio Press Network.
You can read it at the Ohio Pressnetwork dot com.
And you're going to get the first look here, Brian,

(02:38):
because we're going to publish story number two probably later
today or tomorrow. But Ohio Department and Medicaid responded to Devilla,
and I'm sorry to give you the spoiler alert. It's
a lot of bureaucratic gobbledygook that they've provided him, so
his investigation continues.

Speaker 1 (02:52):
I am shocked that you would get gobblygoog in response
to the hard number of reports that he uncovered. And
that was just a sliver, Yeah, a sliver of the
entire medicaid population from one year, a couple of years ago.
So and I guarantee you, and I'm sure you feel
the same way, Jack Windsor that probably things have only
gotten worse, but they certainly haven't gotten better since county.

(03:12):
You're twenty twenty three.

Speaker 2 (03:14):
Well, a couple of things have happened in twenty twenty three.
If you remember, we were just coming out of COVID,
so there were people on the rolls in twenty twenty three.
They estimated about three and a half million highlands. Think
about that, three and a half million highlands. We're receiving
Medicaid payments, our populations probably just north of eleven point
six or maybe close to eleven point seven million people,
So three and a half million people, that's a pretty

(03:35):
sizable number. Now, my understanding is that that that number
has been pared down a little bit because of the
pandemic era qualifications. So on and so forth. But here's
the troubling part. When we looked at the Lexus Nexus
number one hundred and six thousand, five hundred and forty
nine people, that was the number. And by the way,

(03:56):
lexus Nexus only audited about fifty eight percent of the
entire benefitstory population of that ADM segment, so it's just
one segment of that one hundred and six thousand Brian.
What we found in the follow up letter, this is
what we'll publish today or tomorrow, is that of those
one hundred and six thousand people flagged, only six thousand,
twenty three were disenrolled. So you go, okay, there are

(04:17):
one hundred thousand people that were flagged for having assets
well above the threshold. What in had has happened to them?
And the answer de Villa keeps getting from the AHA
Department of Medicaid is twofold. I don't know if you've
ever seen that. Mame of like four or five spider
men standing around. They're all pointing at each other. You
did it, you did it, you did it. It's kind
of like that. The director at the state level says, well,

(04:37):
we don't have those numbers. We can't provide that data specifically,
because the Department of Job and Family Services at the
county level they take care of all of that, and
all by the way, the federal Social Security Administration they
audit the rest of it. Now, Devilla did some digging
and he found that the Social Security Administration, according to
numbers that he received, only audits about eighteen percent of

(04:58):
their population. So when you start a crunching those numbers together,
you go, man, I don't know if it's going to
be six billion in waste, fraud and abuse money going
out the door, but it's billions of dollars that are
being paid without proper oversight. And when you're talking about
taxpayer dollars, you're probably like me, Brian, I want to
make sure that if my money's going out the door,
that it's going to people. And I think we all

(05:19):
agree on this. The people who need it should get it.
There are people who don't need it or getting it.
That's a big problem.

Speaker 1 (05:25):
Well, it's part of the big beautiful bill requiring folks
who are able bodied and not really truly qualifying for
a program that's supposed to help the disabled and and
and needy elderly folks. They're glombing out of the system
without having to participate. I mean, I don't understand how
we've gotten to this place, honestly, sir, I really don't.

(05:46):
But going back to Lexus and Nexus, they're able to know,
they know how much money people have, They're able to
crunch those numbers. So when Lexus Nexus, who you described
as a third party vendor, they are a vendor for
the State of This isn't some random outsourced, you know,
think tank entity that did some separate number crunching. This

(06:06):
is something the State of Ohio relies upon. Correct it is.

Speaker 2 (06:10):
And let me tell you what's really weird about this.
So Lexus and Nexus is actually, I guess a subcontractor
of another third party that the state partners with. Nonetheless,
at the end of the day, our tax dollars are
paying Lexus Nexus for their service, right. And so when
I read Theoha Department of Medicaid's letter two things, the

(06:32):
director Corcoran said, well, Lexis Nexus kind of has this
wrong and shame on them. And I'm thinking, they're your partner,
you're paying them, what are you talking about, right? And
they identified twenty nine percent is the number that I
keep going back to, and they flagged those people to
be removed. I guess my question to the Ohio Department
of Medicaid would be, and I don't think that they've

(06:53):
answered it directly in any of their responses. If you're
paying Lexus Nexus to flag people that are ineligible, why
in hades are you not removing them that? If you're
follow up question, yeah, why are we paying a company
that'd be for service that we're not following up on
and we're not putting into practice The things that they're
telling us might be problematic? Well crazy.

Speaker 1 (07:16):
If you disenroll them, you send them a letter say
we've identified that you have far too much income to
qualify for Medicaid. You are here by disenrolled or otherwise
disqualified from the program. They would have an opportunity to
then go whoa, whoa, whoa, whoa. I don't know where
you got your numbers, but I don't have that kind
of money and make an argument over it.

Speaker 2 (07:34):
Right, that's right. Well, two other stunning things I want
to make sure I unpack here. Based on my preliminary investigation,
Lexus and Nexus isn't just small potatoes. This is a company.
This is stunning to me, And this might be another
story down the road. They have eighty They have access
Brian to eighty eight percent of all banking account information

(07:55):
in the country. That means if you have a name
in a social Security number, they're going to find your
bank account. And so it's not as if, like I said,
there's small potatoes and you know they're just some podunk,
duct tape and bubblegum company in the back room. I mean,
these folks know what they're doing when they're searching for assets.
Here's the other problem. The Oha Department of Medicaid says, well,
Lexis Nexus isn't really used to qualify or disqualify people

(08:18):
because when they're identifying assets, it could include cars and
homes and trust funds and some of those things are excluded.
And again based on my preliminary investigation, Brian, that's wrong.
Lexus and Nexus identifies cash assets. So when we say
that somebody there are four thousand people that have somewhere
between one hundred thousand to nine hundred thousand dollars in assets,

(08:40):
we're talking cash. We identify twelve people who are millionaires.
We're talking cash. So that to me is the blood
on the hands of ODM that we're going to have
to dig into and get clarity on.

Speaker 1 (08:50):
ODM, which is passing the BUCKS saying it's not their
obligation to remove unqualified people from the Medicaid rolls.

Speaker 2 (08:57):
Yeah, that's right, and so Devilla has said, look, I'm
going to write legislation to compel you to follow. I'm
going to open investigations because the General Assembly has oversight
authority to bring them in and question them in suboena records.
But I think what's really going to happen, because of
the way that they've talked to him and Lexus and Eexas,

(09:17):
he's probably going to hope that heads roll. I think
that we probably need to gut that department and get
new leadership that takes seriously the oversight of our tax money.

Speaker 1 (09:27):
It's phenomenal to me, and you know, it's just illustrative
of the broader problem with the government generally speaking. They're
not in business. They don't need to earn the money
they take. They just take it from us, and then
they have no incentive to really follow the money trail
or keep track of our money. There's no fiduciary obligation
by elected officials or people working behind the scenes over
at ODM.

Speaker 2 (09:47):
That's right, and I think there are about seven hundred
employees Brian, and I think probably the third follow up
report we do, we're going to let everybody to know
how much money they make. I think people are going
to be appalled at the money that these folks make.
If you're doing your job, that's one thing. But if
you have potentially even if it's two billion, because that's
what Lexisnex has said, just in that one segment in
twenty twenty three, we've identified two point two billion, and

(10:10):
you extrapolate that over everything at six billion, you have
seven hundred people that can't audit six billion dollars worth
of cash payments. You're doing it wrong.

Speaker 1 (10:18):
Yes, you are six thousand stacks of a million dollars
we're talking about here. It's just the amount of money
is amazing. And all right, Well, this story is going
to continue, and it's got legs for sure, and I
sure hope that they're successful in writing this ship and
for the sake of the American tax payer, let's pivot
over to the Hile budget. I know the sentence proposal

(10:39):
came out with a two point seventy five percent flat
tax and a new way of giving money to the
Cleveland Browns in the form of just handing over money
out of this this fund that they've collected from dormant
bank accounts and uncollected assets, and like they got four
they've been sitting on four point seven billion dollars. Now.
I don't know how they didn't use that money for
other purposes, but amazingly they can pull six hundred million

(11:03):
dollars out of it and hand it to the Cleveland
Browns for this project. The whole concept of doing that
is it just insults me. Jack, Honestly, it really does.
I could say, how come the Bengals don't Kennedy, But
I don't want any tax money going to the CINCINNTI
Bengals either. I mean, these are well healed, wealthy development
groups and owners. They if they want a six hundred

(11:24):
or multi one point two or two points I don't
know how big this project is, but they want it
build it yourself. You know, if it's going to generate
that much tax revenue that you can get the taxpayers
of Ohio to shovel some money in because they think
it's going to generate enough for revenue to pay it back,
then fine, you do it and you take the revenue,
and I know that's just one component of the budget,
but that's the one that's gotten under my skin. It's

(11:45):
more importantly, maybe we focus on the flat tax, which
is going in the right direction.

Speaker 2 (11:50):
VV.

Speaker 1 (11:51):
Ramas Swimming, who I Ramas Swamming, who I believe will
be our next governor. He's in favor of getting it
down to zero, so or at least moving in that direction.

Speaker 2 (11:57):
Jack, Yes, two point seventy five percent flat tax is
what we will see. And I think it's going to
be the second part of the biennium, which I think
just means twenty twenty seven. So we're gonna ratchet down
one bracket and then we're gonna get to that two
point seventy five percent flat tax. Now, everyone that I
talk to, the economists, the people who crunch the numbers,

(12:17):
say that's very attractive for industry, for businesses to relocate here,
because it's attractive for workers. If you say, hey, it's
Ohio has a flat tax. They have a very fair,
very simple income tax structure. That's alluring and so that's
good news to me. What I want to find out, Brian,
And by the way, you have the best in Donovan
O'Neil with Americans for Prosperity. They're all over this. So

(12:42):
Donovan's a great dude, and I'm sure they have some
insight on this. I need to find out today if
there are people who don't pay income tax up to
a certain threshold, right, and so then is that two
point seventy five percent for everybody or is there still
that that standard whatever it is, if you're below twenty
six thousand dollars and in you don't pay taxes. Nonetheless,

(13:02):
two point seventy five percent flat tax is pretty attractive.
Now here's the other component that I think is really important.
You'll get it right, Many in the mainstream press won't.
We're actually spending more on education, because if you read
many of the mainstream newspapers over the past month, they said,
oh my gosh, they're cutting in the education budget. Yeah,
and that's government speak. They wanted eight hundred million dollars

(13:24):
in increases. They only got two hundred and sixty or
two hundred and thirty and they call that a cut.
Last I checked, increasing spending two hundred million dollars is
actually an increase. But they're increasing spending six hundred and
thirty three zero point nine million dollars over the next
two years. But it's going to be merit based, so
schools that have higher performance numbers are going to have

(13:45):
access to more of that money. And then districts because
there's one in East Cleveland, for example, that have dropped
in enrollment by thirty eight percent over the past five years,
and Brian, they kept getting money so they had fewer students.
They kept getting not only money, but more money. Well,
that's going to change. So if enrollment drops, then the
amount of money you get drops. And to your point

(14:07):
about the Cleveland Browns, Sorry, if I'm going along here,
I grew up a Browns fan, which means that, you know,
I guess in some way I'm a glutton for punishment
and I'm patient, but I'm with you. I don't think
sports teams have any business taking taxpayer dollars. Although I
will say this, the last person I talked to on
this said, we're not increasing taxes, We're not giving them

(14:28):
direct bonds. We're going to leverage money that's already sitting around.
They're going to put a bunch of money in the pot.
That way, if we don't meet our return projections, the
Browns will actually pony up money. So I guess at
the end of the day, it might be the best
way to finagle it. But I'm with you. I mean, hey,
I own a news outlet independently, and I want to
look at my senator and go, why don't you give

(14:50):
me money? I'm doing a public service. I just think
it's crazy when we start taking taxpayer dollars and handing
it over, handing that money over to sports teams.

Speaker 1 (14:57):
Well, and the predicate was that this whole comp is
going to generate enough revenue I guess from purchases fifteen dollars,
beer sales and everything like that to basically pay the
the pay Ohio back and form of tax collection. Literally,
every business out there generates revenue in the form of
income tax for the state of Ohio. They generate revenue

(15:19):
with foot traffic. If it's a restaurant, they generate sales
from the sale of food. Everybody, one of my listeners
call up the other day and say, where does the
line form for all the rest of the businesses out
there to stand and get a Hio taxpayer dollars for
their business.

Speaker 2 (15:35):
Yeah, I caught tax cuts, Brian. That's why we've got
to be one hundred percent bullish on a flat tax,
and you know there's going to be a lot to
I think there's there's going to be some stuff in
there about property tax too, and making sure that schools
are very fair with how they advertise and promote their
levies and put them on the ballot. So that's good.
I know that Americans for Prosperity I mentioned Donovan earlier,

(15:57):
they've been working really hard to untangle the complex tax
web here in Ohio, so that I am excited about
because I like keeping more of my own money.

Speaker 1 (16:06):
Amen. Jack Windsor, editor in chief of the Isio Press Network,
host of The Windsor Report on a ninety eight point
nine FM Columbus. I'm sure you can stream it. Check
him out. Jack, It's been a pleasure having you on
my show man. Maybe we can do it again real soon.

Speaker 2 (16:19):
I'd love it. Brian, God bless you brother.

Speaker 1 (16:21):
Take care, have a great week.