• Forecast
  • News Tip
  • Categories
Temperature Precipitation
Estimated read time
2m 56s

State continues crackdown on Medicaid fraud

By Kate McPherson 11:22 PM July 28, 2014

Medicaid fraud costs the state of Alaska $45 million a year, and that’s just a conservative estimate according to Andrew Peterson, assistant attorney general and director of Alaska’s Medicaid Control Fraud Unit. The FBI says up to 10 percent of claims made to Medicaid are fraudulent.

Peterson is currently prosecuting the case of Anchorage physician Dr. Shubhranjan Ghosh, who’s accused of fraudulently billing Medicaid for hundreds of thousands of dollars.

Ghosh is a high-profile case, but there are many cases involving smaller amounts of money that state investigators are turning their attention to. Many of those cases involve a personal care assistant (PCA), who is hired to provide health care and other help in the homes of the elderly and vulnerable adults.

“Medicaid operates essentially in this arena on a system of trust,” Peterson said.

PCAs fill out time sheets and submit them to a PCA agency, which then sends it to Medicaid. Operating on trust means there’s plenty of room for people to be dishonest on their times sheets about hours worked and services provided, especially if the client is a family member.

“The difficulty there in proving that fraud is this service [that] happens in the home, one family member to another, and it’s difficult to encourage individuals to report on their own family members or indicate they aren’t receiving a service that they should,” Peterson said.

In October 2012, the state allocated more money and personnel toward investigating Medicaid fraud. Since then, the Medicaid Control Fraud Unit has overseen 56 convictions. Peterson says it’s a joint effort with multiple agencies and law enforcement involved in gathering the evidence needed for a successful prosecution.

Peterson can’t confirm if fraud is increasing, but he can confirm that the cost of health care is going up – specifically in the home health care arena.

“Just a few years back it was about $60 million a year in cost to the state of Alaska; it’s currently $160 million a year,” he said.

The Department of Health and Social Services (DHSS) has announced it’s going to pilot an electronic visit verification and monitoring system. The system will verify the in-home visit of a PCA.

“The PCA that goes into a home has to make a phone call in to say that they are there and providing a service and that’s how it would work into the time sheet,” said Lynne Keilman-Cruz, chief of quality with the DHSS’ Senior Disability Services.

Keilman-Cruz says even though there are still ways to cheat the system, the electronic visit verification system will discourage fraud. She’s seen it work in other states, she said.

The DHSS also has the power to suspend Medicaid payments while investigations are ongoing. Just in the last two months, Mat-Su Activity and Respite Center, along with Anchorage-based agency A Loving Care PCA, were suspended from billing Medicaid while allegations of fraud are investigated. People who rely on them have been notified and given a list of other providers.

When a PCA or agency is charged, it’s up to the DHSS to make sure vulnerable clients aren’t left without care.

“We work together to triage to make sure the people with higher needs get into services in a timely manner,” Keilman-Cruz said.

There is currently a moratorium on new PCA agencies in Alaska to allow investigations to be completed and regulations to be reviewed.

Latest Stories

  • News

    Hansen victim one step closer to being identified

    by Shannon Kemp on Apr 17, 22:53

    The DNA  of an unidentified victim of deceased serial killer Robert Hansen is now available for comparison with potential family members. Hansen led authorities to the body of a young woman at Horseshoe Lake in Palmer on April 25, 1984. Known as Jane Doe #3, or “Horseshoe Harriet”, she was buried at Anchorage Memorial Cemetery until […]

  • Weather

    Evening News Weather, April 17

    by KTVA Weather on Apr 17, 22:43

    Kenai Peninsula/Prince William Sound Increasing clouds with chance of showers on the Kenai with the heaviest and most steady rain on the eastern side of the peninsula and Prince William Sound. Snow levels are rather high. Southeast Rain showers will increase in the area overnight as some strong warm front push into the area. The […]

  • News

    Spenard Farmer’s Market set to reopen May 16

    by Dave Leval on Apr 17, 22:22

    The Spenard Farmer’s Market will open for business in May in the Chilkoot Charlie’s parking lot, in the same spot where it started five years ago. The new board of directors made the announcement Friday. The previous board canceled the event in February after members said they got burned out from it. Dozens of volunteers […]

  • News

    Alaska March unemployment rate stands at 6.5 percent

    by Associated Press on Apr 17, 20:54

    Alaska labor officials say the state’s unemployment rate in March was 6.5 percent, a slight increase over February’s rate of 6.3 percent. The Alaska Department of Labor and Workforce Development says the latest seasonally adjusted rate compares with the national rate of 5.5 percent. Last year, Alaska’s seasonably adjusted rate for March was 6.9 percent. […]

  • News

    Historic Motherlode Lodge left to burn in Hatcher Pass, considered suspicious

    by KTVA CBS 11 News on Apr 17, 20:31

    The Motherlode lodge in Hatcher Pass was left to burn after catching fire Friday evening. Firefighters were on scene at the fire, but were only there to direct traffic away for public safety. Norm McDonald with the Alaska Division of Forestry says the building was outside any fire service area. McDonald said “it’s lucky” there […]

  • News

    Legislature unanimously passes bill granting volunteer firefighters liability protections

    by KTVA CBS 11 News on Apr 17, 18:25

    Both the Senate and House have unanimously passed a bill protecting volunteer and university firefighters from civil liability. Employees of municipal fire departments are already protected under state law, but Sen. John Coghill says Senate Bill 43 could help others. “Liability protections should not be exclusive to employees of fire departments operated by municipalities and […]

  • News

    20 years later, wounds remain from Oklahoma City bombing

    by CBS News on Apr 17, 18:20

    Timothy McVeigh was executed for bombing the Alfred P. Murrah Federal Building in Oklahoma City 20 years ago this weekend. 168 people, including 19 children, were killed. It was the deadliest act of homegrown terror in U.S. history. Nearly 700 were hurt. Some suffered the kinds of wounds that never heal. The scenes from April […]

  • Politics

    Governor Walker vetoes House Bill 132

    by KTVA CBS 11 News on Apr 17, 16:47

    Gov. Bill Walker has vetoed a bill constricting the authority of the Alaska Gasline Development Corporation in developing a gas line separate from the Alaska Liquified Natural Gas line. Walker had announced his plans to veto House Bill 132 if it reached his desk in a letter to lawmakers April 10, saying it ”significantly reduces Alaska’s […]