JEFFERSON CITY — Missouri officials have prevented over $2 million from being paid out to a company involved in an apparent attempt to scam the state’s Medicaid program.
The amount of money blocked could be even higher as Gov. Mike Parson’s administration continues to investigate several out-of-state laboratories and marketing companies that were seeking to be reimbursed for fraudulent genetic tests done mainly on senior citizens.
The multi-agency probe has been underway since at least July as part of a crackdown on companies attempting to rip off the $10 billion program, which provides health insurance to the poor, disabled and children.
An update on whether additional claims have been rejected since July was not available. State officials also would not reveal the names of the companies being investigated.
“These are ongoing investigations so we unable to provide any further information,” Department of Social Services spokeswoman Rebecca Woelfel told the Post-Dispatch.
An update could come in November when members of a special commission convened by Parson are scheduled to meet in Jefferson City.
The governor announced in December he was forming a panel to investigate fraud and abuse in the Medicaid program, which could cost taxpayers as much as $170 million.
The task force is charged with identifying where Medicaid fraud happens and how to uncover inefficiencies in the system.
Through September, there were nearly 852,000 Missourians enrolled in the state’s Medicaid program. Of those, 523,000 were children.
In August, the administration issued a warning about companies offering free genetic testing to Medicare and Medicaid recipients. Officials said scammers offer cheek swabs for genetic testing in order to obtain an individual’s Medicare or Medicaid information for identify theft or fraudulent billing purposes.
In many cases, the companies are targeting people through telemarketing and booths at public events or health fairs.
Barret Wolters, manager of investigations at the Medicaid audit and compliance division of the Department of Social Services, told the task force that many seniors never receive a response after they provide a sample.
“Participants who agree to provide a saliva sample and answer some questions are told their test results will come back in a few weeks, but very few actually ever receive any results,” he said.
While Medicaid does pay for some genetic screening, it does not typically do so unless it is ordered by a doctor for cancer screening purposes.
In addition to the state investigations, health care companies involved in the task force also are reviewing their records to see if they have been targeted.
“Several attendees indicated they wanted the genetic testing procedure codes that were being billed so they could check their own claims data,” minutes of the July meeting noted.
The push to uncover fraud is part of an effort by the Republican administration to control the cost of the program, which represents about one-third of the state’s general revenue spending.
It comes as hospitals and other health care groups are circulating a petition to get a question on the November 2020 ballot asking Missourians if they want to expand Medicaid.
Currently, to qualify for Medicaid coverage, a Missouri resident must have a household income of 22% of the federal poverty level or be a pregnant woman, disabled senior or parent to a child already in the program.
Expansion supporters generally favor plans to expand Medicaid to individuals who have income at or below about 133% of the federal poverty level.
In addition to targeting the DNA testing companies, the task force also is seeking ways to make it easier to share data in order to halt improper billing issues.