Missouri lawmakers frequently talk about the importance of rooting out waste, fraud, and abuse in state government. But identifying problems is only useful if state agencies actually fix them.
A new report from the Missouri State Auditor shows there is still plenty of work to do. I’ve written before about recurring problems in Medicaid, including state computer systems that can’t communicate, eligibility redeterminations that should be happening but aren’t, and an automated check for recipients who have died that’s not functional. The latest audit found these issues remain largely unfixed, and a new issue involving nearly 10,000 recipients simultaneously enrolled in two eligibility systems.
These problems can result in benefits going to people who no longer qualify or the state paying more than it should, which could amount to hundreds of millions of wasted dollars if not corrected. Of the 16 findings in this year’s audit, nine had been reported previously. To its credit, the Department of Social Services (DSS) agreed with many of the Medicaid findings and says fixes are coming, including information technology improvements that should help address some of these problems.
The response from the Department of Health and Senior Services (DHSS) is much less encouraging. In the Child and Adult Care Food Programs, 50 of 58 DHSS monitoring reviews in which errors were quantified found improper payments, with net over-claims equal to at least 12% of the claims tested. In two cases, every claim tested for the month resulted in an overpayment. Yet DHSS did not expand its review to determine whether those problems extended to other months.
And just like the DSS audit findings, this is not the first time auditors have raised concerns about DHSS oversight of federal food programs. A separate audit last year identified problems in the Child and Adult Care Food Program and the Summer Food Service Program, including providers that were later federally indicted for submitting millions in fraudulent claims. Yet DHSS continues to disagree with the auditor’s recommendations, arguing that its procedures meet federal requirements and that additional monitoring would create an “undue burden” on participants and providers.
While there may be legitimate trade-offs between preventing improper payments and creating costly administrative burdens, when every payment tested is wrong, further investigation seems like a reasonable response. Auditors can identify problems and recommend solutions, but agencies still have to act on those recommendations. If Missouri is serious about reducing waste, fraud, and abuse, next year’s audit should contain fewer familiar findings.
