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WHEELING -- West Virginia Attorney General Patrick Morrisey plans to hire more investigators -- and look closely for doctors providing unnecessary medical services -- when his office takes on the task of Medicaid fraud investigations this fall.
The State Attorney General's Office already oversees the consumer fraud and disability fraud investigative units in the state, and Morrisey believes the Medicaid fraud unit is a natural fit for his office.
Employees looking into Medicaid fraud cases presently are employees of the State Department of Health and Human Resources. That changes when the unit is moved under the Attorney General's Office beginning Oct. 1.
"The synergies we are going to gain in the state are going to be tremendous," Morrisey said. "When you have consumer fraud and disability fraud, it's natural to also be looking at Medicaid fraud. For many years, we didn't have that authority. We think we are going to learn a lot from having this additional information flow in, and I'm excited about it.
"If we are just even moderately successful and can increase our numbers, it means great things for the state and for the federal government and our people."
His office already is looking at what it can do to make the unit more successful, and the first move likely will be to hire more investigators, according to Morrisey. The unit is intended to have 25 investigators, and 11 of those positions are presently open, he said.
"We think there are a number of good things they have been doing," Morrisey said of the investigators. "But we're also going to try and hire additional investigators, and really get down to the core areas of fraud -- whether we are talking upcoding, or the provision of medically unnecessary services."
"Upcoding" occurs when provider bills for a service that is not medically necessary, and that the patient doesn't need, he explained.
"It happens," Morrisey said. "These are some of the issues we will be looking at, but we also think most providers do the right thing. There are always some bad apples out there who have been prosecuted under the "anti-kickback" statute or the false claims statute."
As his office begins to get access to data and see trend lines, it is likely investigators will see trends that will help to target areas where Medicaid fraud is most prevalent, he said.
"If we start to see costs and numbers for certain expenditures going through the roof, you want to make sure -- is that happening because of a medically-necessary condition? Or is that happening because of a rogue provider," Morrisey said. "That's the kind of thing you want to look at."
The amount of money being spent in West Virginia to provide Medicaid services makes it an attractive target for fraud, he said. The state of West Virginia spends over $3 billion annually providing Medicaid services to eligible residents, according to Morrisey.
"Where there is money, there is an opportunity for fraud. People will attempt to steal from the system," he said.
The potential amount of savings that could result by increasing attention on Medicaid fraud isn't yet known, Morrisey said.
"We're looking to continue to save money for West Virginia," he said. "I know we have had a lot of success with consumer fraud and disability fraud, and our goal is to keep moving the needle higher and higher where West Virginia is saving more money. I think there is that opportunity -- especially if we are able to add to the roster of talent in the office."