New data suggests Iowa continues to understaff and underfund its offices tasked with investigating Medicaid fraud and patient abuse.
All 50 states have Medicaid Fraud Enforcement Units (MFCU), which are tasked with investigating abuse and neglect of Medicaid recipients as well as financial fraud by Medicaid-funded health care providers. Like Medicaid itself, MFCU’s operating costs are paid for with a combination of state and federal funds.
MFCUs nationwide typically recover $3.35 for every tax dollar spent through civil penalties resulting from fraud investigations. Last year, MFCU collected a total of $1.2 billion from taxpayers and secured 329 convictions for patient abuse and neglect, according to a new report from the U.S. Department of Health and Human Services Office of Inspector General.
The amount of resources each state spends on its anti-fraud division typically has some correlation to the amount it spends on Medicaid. Historically, however, Iowa has provided far less funding to MFCUs than states with comparable Medicaid spending.
In 2022, five states had Medicaid budgets within $1.5 billion of the $8 billion that Iowa Medicaid spent that year, according to the latest data from the National Association of Medicaid Fraud Enforcement Agencies. All these states had his MFCUs with budgets 2-4 times his in Iowa’s division.
In fact, some states with much smaller Medicaid budgets than Iowa spend significantly more on their fraud prevention departments. Indiana, for example, spent just $2.9 billion on Medicaid in 2022, less than half of what Iowa spent that year, according to the association. But Indiana allocated $8.4 million to its Medicaid fraud unit, more than six times the $1.3 million Iowa provided for such operations.
According to the association, in 2022, Arkansas’ total spending on Medicaid was about the same as Iowa’s, but MFCU’s budget was more than double Iowa’s.
General questions for inspectors: Funding, staffing
The Iowa MFCU, which is housed within the Iowa Department of Inspections, Appeals and Licensing, will have a total of nine employees, including five staff members, as of 2022, according to the national association. Only four other states in the nation had fewer total MFCU personnel, and only nine states had fewer investigators.
In 2022, the U.S. Department of Health and Human Services’ Office of Inspector General reviewed the operations of Iowa’s MFCUs and praised them for operating effectively and achieving “high case outcomes.” But the inspector general also said the force was leaving vacancies and not maintaining independently approved staffing levels.
“Low staffing” was in part the result of “significant turnover of investigators,” which contributed to the increase in caseloads, the inspector general said. Iowa spends approximately $759 million on Medicaid per MFCU employee, and only two other states in the nation report a large gap between total Medicaid spending and investigative spending.
Iowa’s staffing problems go back several years, according to federal data. The Iowa unit was approved to hire 11 employees in 2019, 2020 and 2021, but actually employed seven or eight at the end of each year. The inspector general reported that nearly all of the vacancies at the time were for investigator positions, and although the budget authorized seven investigators, only four were hired at the end of each fiscal year. He pointed out.
The inspector general also found that six agents left the force over a three-year period. Four of them were only employed for short periods of time, from one week to 15 months, and two of them did not complete their six-month probationary period.
Even with all vacancies filled, the Iowa unit’s staffing levels remain low compared to other fraud enforcement units across the nation, the inspector general reported. Staffing shortages meant investigators were working on up to 20 cold cases at a time, far exceeding the force’s recommended number of 12 to 15, the inspector general reported.
The inspector general recommended that Iowa evaluate the adequacy of the force’s staffing levels, stating that increasing staffing “ultimately strengthens the force’s ability to protect the Medicaid program and its beneficiaries.” It will become.”
The state did not agree to this. After the inspector general’s visit, he hired additional investigators but maintained that current staffing levels were sufficient.
DIAL Director Larry Johnson told the Office of the Inspector General that “nine full-time employees are sufficient to operate effectively and efficiently at this time.” “Specifically, five researchers are sufficient to accommodate our current referral intake.”
The department said it has a “sufficient caseload to keep our investigators working hard” and is not “using tax dollars to hire unnecessary personnel.”
The Iowa Capital Detachment’s report to the Iowa Medicaid Fraud Enforcement Bureau was referred to the Iowa Department of Inspections, Appeals, and Licensing, which did not provide any comment on the National Association of Medicaid Fraud Enforcement Bureaus’ data or the inspector general’s recommendations. Rejected. Quoting Johnson’s letter.
Iowa man charged with abuse and fraud
Recent criminal cases brought by the Iowa Medicaid Fraud Enforcement Unit include:
Christina Sue ArcherThe 43-year-old Centerville resident was charged last year with a misdemeanor count of falsifying medical records. She was accused of falsifying patient treatment records to cover up 33 separate incidents in which she falsely claimed to have provided 164 hours of home health care services to Medicaid recipients.
Archer was also charged with felony fraud for allegedly depriving Medicaid of $8,136 through his actions. According to her court records, she worked at a hospital and clinic in Knoxville at the time of her indictment. Her felony charges were dismissed and Archer pled guilty to her charge of tampering with records and was fined $855 and sentenced to two years of probation.
bianca beam guardThe 21-year-old Mount Aire resident was indicted in 2023 on one count of misdemeanor abuse of an adult by custodian injuring personal decency.
Beamgaard, who worked at an Iowa nursing home run by Care Initiative Inc., allegedly used his cell phone to record videos of residents covered in feces and posted them on social media platforms. She later pleaded guilty and was fined $430 and sentenced to one year of probation. She received her suspended sentence in this case, and her conviction will be expunged from her public court record after her probation period ends.
jamie leah jenkinsThe 39-year-old Fort Madison resident was charged in 2020 with felony identity theft, felony fraud, felony forgery and misdemeanor counts of falsifying records. She is accused of creating at least 12 medical bills by falsely claiming to have paid medical bills to Medicaid recipients. Her fraudulent claims totaled $7,000.
She was working at Hope Home Care at the time of the charges, according to court records. She pleaded guilty to fraud charges, was sentenced to five years’ probation, and ordered to pay $9,663 in restitution. Her remaining charges were dismissed.
