(C) Iowa Capital Dispatch
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Data suggests Iowa's Medicaid investigators are understaffed, underfunded • Iowa Capital Dispatch [1]
['Clark Kauffman', 'More From Author', '- March']
Date: 2024-03-19
New data suggests Iowa continues to understaff and underfund the office charged with investigating Medicaid fraud and patient abuse.
All 50 states have a Medicaid Fraud Control Unit, or MFCU, that is tasked with investigating abuse and neglect of Medicaid beneficiaries, as well as financial fraud perpetrated by Medicaid-funded medical providers. Like Medicaid itself, the MFCU’s operations are paid for with a mix of state and federal funding.
Collectively, the nation’s MFCUs recover $3.35 for every tax dollar they spend, usually through civil penalties that stem from fraud investigations. A new report from the Office of Inspector General at the U.S. Department of Health and Human Services says that last year, the MFCUs recovered a total of $1.2 billion for taxpayers and secured 329 convictions for patient abuse or neglect.
The amount of resources each state spends on their fraud control unit generally has some correlation to the amount of money they spend on Medicaid. Historically, however, Iowa has provided far less funding for its MFCU than states with comparable Medicaid spending.
According to the latest data from the National Association of Medicaid Fraud Control Units, there were five states that in 2022 had Medicaid budgets within $1.5 billion of the $8 billion spent by Iowa Medicaid that year. All of those states had MFCUs with budgets that were two to four times that of Iowa’s unit.
In fact, some states with far smaller Medicaid budgets than Iowa spend significantly more on their fraud control units. Indiana, for example, spent only $2.9 billion on Medicaid in 2022, according to the association, which was less than half of what Iowa spent that year. But Indiana allocated $8.4 million for its Medicaid Fraud Control Unit, which was more than six times the $1.3 million Iowa provided for such operations.
According to the association, Arkansas’ total spending on Medicaid was almost identical to that of Iowa in 2022, but its MFCU budget was more than double that of Iowa’s.
Inspector general questions funding, staffing
The Iowa MFCU, which is housed within the Iowa Department of Inspections, Appeals and Licensing, had a total of nine staffers in 2022, which included five investigators, according to the national association. Only four other states in the nation had fewer total MFCU staff, and only nine had fewer investigators.
In 2022, the Office of Inspector General for the U.S. Department of Health and Human Services reviewed the work of Iowa’s MFCU and praised it for operating effectively and achieving “high case outcomes.” But the inspector general also said the unit was leaving positions vacant and was not maintaining its own approved staffing levels.
The “low staffing levels” were partly the result of a “significant turnover of investigators” which in turn contributed to high caseloads, the inspector general stated. Iowa was spending about $759 million on Medicaid per MFCU employee, at a time when only two other states in the nation were reporting a higher disparity between total Medicaid spending and spending on investigations.
Federal data indicates Iowa’s staffing issue dates back several years. Although Iowa’s unit was approved for 11 employees in the years 2019, 2020 and 2021, it actually employed seven or eight individuals at the end of each of those years. Nearly all of the staff vacancies during that time consisted of investigator positions, the inspector general reported, noting that while the budget had allowed for seven investigators, only four were employed there at the end of each fiscal year.
The inspector general also found that during the three-year period, six investigators had left the unit. Four of them were employed there only a short time – one week to 15 months – and two of those four didn’t complete the six-month probationary period.
Even if all of the vacant positions were filled, the inspector general reported, the Iowa unit’s staffing levels remained low compared to all other fraud-control units in the nation. The staffing shortage resulted in the investigators handling as many as 20 open cases at a time, far above the unit’s preferred caseload of 12 to 15 cases, the inspector general reported.
The inspector general recommended that Iowa assess the adequacy of the unit’s staffing levels and said adding more staff “would ultimately enhance the unit’s ability to protect the Medicaid program and its beneficiaries.”
The state disagreed. While it hired an additional investigator after the inspector general’s visit, it argued that its current staffing levels were sufficient.
“Nine full-time employees are adequate at this time to operate effectively and efficiently,” DIAL Director Larry Johnson told the inspector general’s office. “Specifically, five investigators are sufficient to respond to current referral intakes.”
The unit, he said, had “reasonable caseloads to keep investigators working diligently” and was not “using taxpayer funds to employ unnecessary personnel.”
The Iowa Capital Dispatch’s calls to the Iowa Medicaid Fraud Control Unit were referred to the Iowa Department of Inspections, Appeals and Licensing, which declined to comment on the data from the National Association of Medicaid Fraud Control Units or the inspector general’s recommendations, other than to cite Johnson’s letter.
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