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Mountain State Centers for Independent Living supports legislation that requires the state Medicaid agency to furnish Medicaid recipients monthly itemized statements of all assistance or services claimed to facilitate the verification of the accuracy of stated claims.

In 1965, the Medicaid Program was established to help cover the cost of medical services for certain individuals and families with low incomes and resources who could not pay for medical care. Medicaid is a joint federal and state program. Centers for Medicare and Medicaid Services (CMS) report that "Medicaid is the largest source of funding for medical and health-related services for people with limited income." Each state sets its own guidelines for eligibility and provision of services. Each state must cover mandatory services as outlined in the federal statute, however, states can also chose to cover optional services. To read more about West Virginia's Medicaid Program you can visit this Web site: www.wvdhhr.org/bms

According to the "The Primer for States, Health Plans, Providers and Advocates", West Virginia has 342,668 Medicaid Recipients. This is equivalent to 19% of our overall population. Medicaid expenditures totaled approximately 1.3 million dollars with an average of $3,932 per person.

Over the last several years, West Virginian's taxes have been increased due to the budgetary shortfall of our state's Medicaid program. Again, this year we have already heard the state's medicaid program continues to be troubled. By supporting medicaid reporting and requiring this type of legislation, we could ensure that West Virginia doesn't lose Medicaid dollars due to fraudulent acts.

Our research revealed that hundreds of thousands of dollars of welfare fraud occur each year in our state. Just during a five month period in 2001, the WVDHHR, Office of Inspector General's Investigation and Fraud Management Division, actively tracked nearly 70 welfare fraud cases.

CMS's Medicaid & Fraud Division has developed tips to prevent fraud and their FIRST recommendation is that Medicaid recipients review their Medicaid bill to make sure that Medicaid has been billed for medical services they actually received. However, the State of West Virginia, has no mechanism in place for recipients to review their Medicaid statements. Hence, our support for SB 207 and HB 2759 during the 2003 WV Legislative Session. Once again, we are supporting a medicaid reporting bill in 2004 that includes:

• a detailed monthly statement itemizing all billing for services or assistance claimed by the provider
• the statement would contain the name of the provider, date of service, medicaid billing code, description of the service, and the number of units billed
• the statement must be reviewed, verified, and signed by the recipient that they received these services
• if the statement included services not received, the recipient would be required to notify the Department Health and Human Resources
• the Department Health and Human Resources will investigate the discrepancy and act accordingly

Tips to Prevent Fraud

According to the CMS, there are things you can do to help fight fraud and abuse in Medicaid.

• Look at your Medicaid bill carefully to make sure that Medicaid has been billed for medical services or goods that you really received. Check to see that the date of service is correct.
• DO NOT give your Medicaid card number to anyone except your doctor, clinic, hospital, or other health care provider.
• DO NOT ask your doctor or other health care provider for medical care that you do not need.
• If you are offered free tests or screenings in exchange for your Medicaid card number, be suspicious.
• If it sounds too good to be true, it probably is. Be careful about accepting Medicaid services when you are told they will be free of charge.
• If anyone claims they know how to make Medicaid pay for health care services or goods that Medicaid usually does not pay for, you should avoid them.
• DO NOT let anyone borrow your Medicaid card.

If you suspect fraud, report it!! Call the National Fraud Hotline at 800-447-8477.

Updated: January 17, 2004