HARRISBURG, PA — A recent report from the U.S. Department of Health and Human Services names Pennsylvania as the top state in filing Medicaid fraud charges and third in securing convictions. This achievement reflects the concerted efforts of the Department of Human Services (DHS) and its robust fraud prevention and detection systems that safeguard taxpayer dollars and protect vital resources for eligible residents.
“As DHS builds bridges to health and stability for eligible Pennsylvanians through Medicaid and our other supportive programs, we must be sure that taxpayer dollars are being used as intended and be vigilant in protecting these critical resources,” said DHS Secretary Dr. Val Arkoosh.
The DHS Bureau of Program Integrity (BPI) plays a pivotal role in ensuring program integrity. The bureau utilizes advanced analytics, including AI-powered fraud detection systems, to monitor Medicaid usage, verify income eligibility, and identify potential cases of fraud or abuse. For the 2023-24 fiscal year, these efforts resulted in nearly $500 million recovered or avoided costs through measures such as identifying alternative payment sources and removing non-compliant providers. Notably, 325 providers were terminated for misconduct, saving the program $33.7 million.
Collaboration remains vital to the state’s success. DHS works closely with the Office of State Inspector General (OSIG) and the Office of Attorney General to investigate flagged cases. Last year, OSIG investigated over 19,000 applications flagged for misinformation, many referred by DHS.
“As Attorney General, combating Medicaid fraud was a critical priority, and it is gratifying to know that this work has safeguarded Pennsylvanians while holding criminals accountable,” said State Inspector General Michelle Henry. “Our dedicated agents work to investigate and prevent fraud, ensuring the integrity of public assistance programs.”
Pennsylvania’s commitment to integrity and accountability has not only secured critical Medicaid funds but also set a national benchmark in combating fraud. State leaders affirm their dedication to protecting these resources for those who truly need them.
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