• Forecast
  • News Tip
  • Categories
News Alert: Latest updates on McHugh Creek Fire - Read More
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

  • Crime

    Caught on video: Driver rams SUV with toddler inside

    by Eric Ruble on Jul 24, 23:07

    An Anchorage couple is asking for help identifying the driver of a blue Ford F-150 after being chased and rammed repeatedly by the unknown vehicle Friday evening. Cell phone video making rounds on social media this weekend shows couple’s view from inside their sport utility vehicle as it was hit repeatedly by the pickup truck. Grace […]

  • News

    Aussies won’t move to Rio village yet; power, plumbing fears

    by Stephen Wade / AP Sports Writer on Jul 24, 17:52

    RIO DE JANEIRO — Australia’s Olympic team leader is keeping the delegation’s 700 athletes or staff out of the Athletes Village for at least two days, citing electrical and plumbing problems in the sprawling complex less than two weeks before the start of the games in Rio de Janeiro. “Electricity and water is not a […]

  • News

    AST: Man’s body found floating near Ketchikan

    by KTVA CBS 11 News on Jul 24, 16:44

    An unidentified man’s body was found floating in the Tongass Narrows near Ketchikan Saturday evening, according to Alaska State Troopers. Troopers responded to the 4700 block of the North Tongass Highway around 6:45 p.m. after receiving a report of a body. The man’s body was brought to shore shortly after that, according to an online trooper […]

  • News

    Police: Man, likely attacker, dies in explosion in Germany

    by Associated Press on Jul 24, 16:31

    Police in the southern German city of Ansbach say a man was killed when an explosive device he was believed to be carrying went off near an open-air music festival, injuring 10 people. Ansbach police said in a statement early Monday that just after 10 p.m. Sunday they were alerted to an explosion in the […]

  • Crime

    Woman wanted on felony warrant following early morning fight involving multiple people

    by KTVA CBS 11 News on Jul 24, 14:53

    The Anchorage Police Department is actively searching for a woman for whom they’ve obtained a felony warrant following a fight involving multiple suspects on Russian Jack Drive. Multiple people called APD around 4:19 a.m. to report a fight on the 1600 block of Russian Jack Drive. When police arrived, they spoke with a woman who […]

  • News

    Search underway for California man missing in Denali National Park

    by KTVA CBS 11 News on Jul 24, 14:44

    About 40 people are helping the search for Mukunda Egen, a 42-year-old California man who was last seen on Friday night while hiking in Denali National Park and Preserve. Egen and a friend set up a campsite at the Teklanika Campground and decided to hike from that area Friday afternoon, according to a statement from […]

  • News

    ‘True friends’ help Hillside alpaca farm owner prepare for fire

    by Eric Ruble on Jul 24, 11:46

    On a street up Potter Valley Road, about a dozen houses enjoy a spectacular view of the Cook Inlet. However, they are also some of the closest homes to the McHugh Creek Fire. One of those houses is owned by Michelle Coburn, who also runs a small alpaca farm on her property. She said she […]

  • Crime

    Police search for halfway house inmate charged with assault

    by KTVA CBS 11 News on Jul 24, 11:28

    ANCHORAGE — The Anchorage Police Department is looking for 33-year-old Webster Leavitt, who escaped from the Cordova Center Saturday night. According to a statement from police, Leavitt kicked out his window at the halfway house and ran away. Leavitt was last seen wearing a gray shirt and blue jeans, police said. He is 5-feet-10-inches tall, […]