SPRINGFIELD — More than 2 million people are on Medicaid in Illinois, and thousands of doctors, hospitals and pharmacies service a system that costs more than $16 billion a year.
But something may be amiss. The state’s main Medicaid cop last year sent just 38 cases of fraud to police and prosecutors across the state.
The Illinois Department of Healthcare and Family Services’ inspector general is the main investigator of fraud in the state’s sprawling Medicaid system and, in 2012, the OIG terminated 144 providers and 511 Medicaid clients, a tiny fraction of those in the system.
Now, lawmakers hope a new law will give the nearly toothless watchdog a bit more bite.
“It’s really alarming to me when providers start abusing the system,” state Sen. John Mulroe, D-Chicago, said, referencing the genesis of the law he sponsored. “Unfortunately, we’re going to have to live with people abusing the system … but when providers start abusing the system, that really, really concerns me.”
Mulroe’s law, signed by Gov. Pat Quinn earlier this week, would allow the inspector general at HFS to seek felony charges against anyone working for a Medicaid provider who commits fraud.
HFS’ own report shows actions against Medicaid vendors saved about $34 million, either by recouping money or not spending it. Actions against Medicaid clients saved about $4 million over the same time.
Still, Illinois’ savings were less than half of 1 percent of what the state spends on Medicaid each year.
State Rep. Patti Bellock, R-Hinsdale, said surely the state has more than 38 fraud cases, but she worries it cannot prosecute them all.
“Most state’s attorneys do not want to take on a case,” said Bellock, adding that many local prosecutors fear the amount of money is too small. “But it’s not small. It’s certainly not small anymore.”
Bellock points to a private audit of Illinois’ Medicaid system that found one in three people enrolled in the system are ineligible.
“We know we have so many people who are scamming the system,” Bellock said. “Are we supposed to just let it go?”
Bellock and some other GOP lawmakers want to give HFS even more power to prosecute fraud.
But that new law may come after Illinois adds between 300,000 and 600,000 people to the rolls in 2014 as the state expands Medicaid as part of Obamacare.
Bellock said if Illinois can’t contain fraud and Medicaid costs now, the state will lose even more.
“I think HFS just needs the tools to (prosecute fraud) on their own,” Bellock said.
Contact Benjamin Yount at Ben@IllinoisWatchdog.org and find him on Twitter @BenYount.