• 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

  • Politics

    Panel pitches plan to eliminate cashable oil tax credits

    by Associated Press on Apr 24, 21:51

    JUNEAU, Alaska (AP) – An Alaska Senate committee has proposed eliminating cash credits for oil and gas companies that lawmakers have increasingly come to see as unaffordable. The proposal doesn’t delve as deeply into oil tax policy as the version that passed the House. But the Alaska Oil and Gas Association says an initial review […]

  • Ex-‘Deadliest Catch’ star arrested on drug charges

    by Associated Press on Apr 24, 21:47

    PHOENIX (AP) – A former reality television star has been arrested in Phoenix for alleged vehicle theft and drug possession. Phoenix police say 31-year-old Jacob Harris was released on his own recognizance Monday after his initial court appearance. He faces a May 5 status conference. Harris was on Discovery channel’s “Deadliest Catch” series. According to […]

  • We may be underestimating whale-boat collisions

    by Associated Press on Apr 24, 21:34

    PORTLAND, Maine — A group of marine scientists says collisions of whales and boats off of the New England coast may be more common than previously thought. The scientists focused on the humpback whale population in the southern Gulf of Maine, a body of water off of Massachusetts, New Hampshire and Maine. They found that […]

  • Man gets 4 years in Anchorage bank robbery

    by KTVA Web Staff on Apr 24, 21:25

    An Anchorage man has been sentenced to serve four years behind bars following a conviction for a 2016 bank robbery. Scott Hartvig McDowell, 49, was sentenced to four years in prison and three years of supervised release in connection with the Alaska USA Federal Credit Union robbery that occurred on August 2, 2016. McDowell presented […]

  • News

    Aurora watchers spot something new in night sky

    by CBS News on Apr 24, 21:00

    Citizen scientists looking at the northern lights appear to have stumbled upon a new natural phenomenon. Members of the Facebook group Alberta Aurora Chasers posted photos of a mysterious purple streak cutting through the night’s sky. In their early posts, the group’s members referred to the streak of purple light as a “proton arc” — […]

  • Juneau playground fire ‘possibly arson’

    by KTVA Web Staff on Apr 24, 20:52

    A fire broke out Monday evening at a popular child’s playground in Juneau. The Twin Lakes playground went up in flames in the 5 o’clock hour Monday evening, and the $250,000-worth of playground equipment is a total loss. No injuries were reported, according to Capital City Fire and Rescue. The Fire Marshal is investigating the […]

  • News

    Alaskans might need passport for flights, military base access

    by Liz Raines on Apr 24, 19:38

    If state lawmakers don’t pass new legislation soon, Alaskans may not be able to use their  State of Alaska driver’s license to fly or access military bases.  That’s because of the Real ID Act passed by Congress in 2005, designed to create minimum security standards for all state ID cards nationwide. Now, 12 years later, the […]

  • News

    Crowd packs 4th Avenue Theater meeting

    by Lauren Maxwell on Apr 24, 17:49

    Meetings of the State’s Historic Preservation Commission don’t always draw big crowds, but on Monday morning, the room was packed. People came to testify before the Commission as to why they believed Anchorage’s 4th Avenue Theater should be designated a historic monument by the state. Judy Bittner, chair of the commission, said the hearing was […]