IG Hits City's Medicaid-Fraud Unit; Reinspection Finds Understaffing, Poor Management

The Washington Times (Washington, DC), June 24, 2003 | Go to article overview

IG Hits City's Medicaid-Fraud Unit; Reinspection Finds Understaffing, Poor Management


Byline: Brian DeBose, THE WASHINGTON TIMES

A manpower review of three troubled D.C. government agencies is on track, but moving slowly even as the D.C. inspector general reported substantial personnel problems in one of them, city officials said.

In a second review of the Medical Assistance Administration (MAA), D.C. Inspector General Charles C. Maddox found the agency within the Department of Health to be woefully understaffed, poorly managed, lacking necessary training for workers and not using new computer systems that could improve productivity.

"Our re-inspection found that 35 of the 45 original recommendations were in full compliance, with three in partial compliance and seven not in compliance," Mr. Maddox said in his report.

Much of his criticism was focused on MAA's Surveillance and Utilization Unit . The unit is responsible for weeding out fraudulent Medicaid claims and ensuring that the city isn't losing money covering hospital care costs for ineligible patients.

During the first review in April 2000, Mr. Maddox found that the surveillance unit had only "five employees" to review 30,000 service providers and 125,000 Medicaid recipients.

"Medicaid is a billion dollar program in the District. If you consider that 10 percent of all claims are lost to fraud according to the national average, and that [MAA] has not fixed the problem in the past three years, that results in nearly $300 million lost in Medicaid funding in that time period," said an official in the Inspector General's Office.

The Washington Times reported last month that the District was conducting a manpower review in the Health, Human Services and Metropolitan Police departments.

Herbert R. Tillery, the deputy mayor for operations who is conducting the review, said in recent weeks it has been moving more slowly since he shifted more personnel to investigate credit-card usage irregularities in the Office of Property Management.

During the second review of the agency, which ended in April, Mr. Maddox found the surveillance unit was still understaffed.

Tens of thousands of Medicaid claims are filed each day, but Mr. Maddox said the unit only has 11 employees working in two divisions the newly created Office of Investigations and Compliance and the Post-payment Review Office.

"Three of the four employees in the unit are newly hired and unable to work independently, leaving only one experienced staff member," Mr.

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