Washington State Failed to Suspend Payments to Medicaid Providers Accused of Fraud

The state of Washington did not suspend payments to numerous Medicaid providers who had been accused of fraud, putting state and federal funds at risk, according to a new government report.

The audit, released by the Office of Inspector General of Health and Human Services, reviewed Washington’s Medicaid payment suspensions in accordance with Obamacare and found that the state failed to act in several cases involving potentially fraudulent providers.

The state, the report said, “repeatedly failed to suspend payments because it did not follow its policies and procedures.” Written policies and procedures to suspend Medicaid payments to providers who had credible allegations of fraud against them were not in place, according to the report.

The audit found that of the 81 providers who posed a risk of fraud, the state suspended Medicaid payments to 33. Payments to the remaining 48 providers who raised red flags were not suspended, an action required by federal regulations.

One such provider was the subject of an ongoing investigation into possible fraud in October 2014, but it continued to receive payments from the state. The provider received $1,588—$794 of which came from the federal government—in payments that were not eligible for federal reimbursement.

The state also failed to suspend 47 providers that together accounted for $989,766 of Medicaid payments before investigations or legal proceedings were finished. The federal government’s share of these questionable payments was nearly $500,000.