Legislative Joint Auditing-Medicaid Subcommittee
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I call the medicaid subcommittee of legislative joint auditing Committee to order the chair sees a
Speaker 3
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quorum I'd like to ask Representative Vaut to say a prayer to open us our most gracious heavenly Father we praise you and we thank
Representative DeAnn Vaught
Unverified
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you for this another day and for all your many blessings Lord God. I pray today as we do this for our lord God that we bring honor and glory to your name.holy Father, I pray that you lead God and direct us all to your path of righteousness and it's in Jesus Christ's beautiful name I do pray amen thank you Representative Vau
the first item of business is to on the agenda is the adoption of the minutes from November of 2018 those minutes have been sent out via email either yeah that's all right right is there a second? representative long all those in favor say aye any opposed the minutes are adopted thank you so
the purpose of this meeting obviously we haven't met in quite a while and senator flippo, Chairman
Lundstrom we thought it would be a good idea to bring together kind of a primer if you will or a primer on the medicaid audit subcommittee and so I've asked four different agencies to come and kind of speak about what they do and how the process works when it comes to medicaid audit and so we have some time constraints because there is an executive committee meeting at 11:30 so I've got a hard stop at 11:15 so I've asked each of the agencies to kind of limit their questions or their presentation to about 10 minutes and then we will hold questions until everyone is presented and that way we're
sure we get through all the information and then we'll have questions so write your questions down and we'll address them afterwards. Any questions before we move forward? Fantastic. so the next item on the agenda is an overview of medicaid subcommittee by legislative audit staff and we'll begin with the history of the medicaid subcommittee so Tim Jones you are recognized to provide a history of the subcommittee
Speaker 13
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thank you madam chair the legislative joint auditing medicaid subcommittee has met a total of 8 times before today. as shown on the slide, the
subcommittee met twice in 2012 on back to back days once in 2015 twice in December of 2016 and three times in 2018. in ute s for the November 1st,2018 meeting which was the last meeting indicate future meetings will be at the call of the co-chairs if necessary. According to the minutes from the first meeting on July9,2012. The Medicaid subcommittee was created initially due to questions regarding a
legislative audit special report on Medicaid mental healthal services for fiscal years 2006 through 2011 Medicaid meeting topics included but were not limited to questions about legislative audit reports and findings, Medicaid services, healthcare provider charges eligibility for services and questions for Department of Human Services staff today we have representatives from legislative audit, Department of Human Services,
the officefice of Medicaid inspector general and the attorney general's office to give brief presentations regarding their respective roles with medicaid and general information on Medicaid. madam chairir, this concludes my presentation on the history of the medicaid subcommittee. Thank you.taff will now present a summary of legislative audit's role related to
Medicaid, Davidessaway you are recognized thank you madam Chair. The purpose of this presentation is to provide an overview
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of the statewide single audit and
legislative audit's role as it relates to Medicaid. the annual work related to Medicaid is largely performed in Arkansas's statewide single audit. This is an annual audit of nonfederal entities expending federal awards to a lesser degree some agency reported frauds could be reported on the annual financial audit of the department of Human Services. The Single Audit Act of 1984 established requirements for audits of states, local governments and tribal governments that administer federal financial assistance programs also known as federal
awards or federal programs The Single audit Act amendments of 1996 extended the statutory audit requirement to nonprofit organizations and substantially revised various provisions of the 1984 Act. wo CFRart 200, also known as uniform guidance, establishes its administrative requirements cost principles as well as audit requirements for federal awards The Office of Management and Budget OmB is the federal office that prescribes what must be tested in the single audit.
However, OMB does not require all federal programs to be audited every year some large federal programs in the state can be tested only every3rd year if they have had no material weakness findings in the previous audit. However, medicaid is not one of those programs because medicaid has historically been identified by OMB as highri. it must be audited every year as such we audit Medicaid every year Medicaid is the largest federal program in the state reporting6.5 billion dollars
or53% of the state's $12.2 billion in federal expenditures and the most recent single audit for the year ended June30,2024. in addition to the federal funding provided by the United States Department of Health and Human Services the state is responsible for matching those expenditures according to a computed rate called the Fmap or federal Medical Assistance percentage the chart on this s on this slide shows federal and state expenditures for the previous four years under audit as well as the engagement year currently in process fiscal year 2025.
the CmS64 reports are quarterly expenditure reports that are filed by DHS with the federal grantor. The United States Department of Health and Human Servicesenters for Medicare and Medicaid Services or CmS for short. OMB issues a yearly compliance supplement with instructions to auditors on which areas and which steps should be performed in assessing compliance with federal regulations and state policy. a riskbased materialityrin approach is used in the planning of the audit work which generally includes a review of the following
eligibility of clients and providers claims paid on behalf of clients fulfillment of the state's expenditure matching obligations a reconciliation of financial information to reports filed by the agency pe ci al tests prescribed by the compliance supplement for nuanced objectives that have a less monetary focus than other areas also the state's implementation of internal controls for all of these areas must be tested.
Unknown speaker
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What have I done? how about you umhummost there.
Speaker 35
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there you go you should be back you know one you go you're back now thank you audit findings discovered as a
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result of our audit procedures are communicated to agency management and a formal exit conference Responses to those findings are collected from the agencies and they are submitted along with the findings to the federaleral Clearingho prior to the March31st deadline. Theeder clearing house is a public portal through which CmS, the federalgrantor, receives these findings and follows up with the state the single audit is presented to the full legislative joint auditing committeetee meeting annually usually around June. the audit cycle continues the next year when subsequent year auditors perform follow up procedures to determine if
corrective action has been taken on these findings which includes collecting management decision letters from the Arkansas DHS which document the resolution of these audit findings with the federal grantor Cms this chart shows the number of audit findings for the medicaid program for the previous five fiscal years in addition to the single audit finding process discussed earlier a medicaidrelated finding may be reported in the departmentalinancial audit report for DHS Those findings are presented at a meeting of the LAC Standing Committee on state agencies and I'll discuss
those types of findings after the single audit findings the findings in the Fy24 single audit can be summarized as follows deficiencies were noted in internal controls over the data matching used to identify medicaid recipients who are no longer eligible for programs due to death or incarcerations costst paid for a contractor's work and the managerial accounting section were paid using 100% Medicaid funds when the work performed was only68% related to Medicaid deficiencies were noted to
properly s suspending and reinstating benefit coverages of incarcerated juveniles defficiencies were noted well yeah I had a ok give
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deficiencies were noted in the internal controls over the eligibility of recipients
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also the state had not established a medicaid recovery audit contractor or reck program.eder pro federal code requires states and territories to establish programs to contract with one or more medicaid reckx to identify underpayments and overpayments and recoup those overpayments. state may request an exception to some or all of the Medicaid rack requirements which is what the what Arkansas has done in response to this finding
also overpayments recovered as a result of the medicaid fraud control unit or Mafuku for short casework were not properly reflected and the quarterly CmS64 expenditure reports. Finally, deficiencies were noted in the internal controls over properly supporting provider eligibility determinations the findings in the Fy24 single audit were presented to and filed by the legislative joint auditittee and the meeting held on Friday June6th of 2025 we are following up on these
findings in the Fy25 single audit which we anticipate to be presented in the June Ljack meeting. the finding in the Fy24 departmental audit of DHS can be summarized as follows DHS discovered and reported to ALA14 of its employees who provided false or incomplete information to receive benefits to which they were not entitled.13 of these employees received7,985 dollars in benefits through the disaster supplemental nutritional
Assistancegrame or DSnap. the remaining employee received5,837 dollars in Medicaid benefits the agency notified legislative audit of the apparent theft of public funds as required by Arkansas code it's a statutory requirement for legislative audit to collect fees and refer them to the prosecuting attorney as well as the attorney general The FY24 departmental audit of DHS was initially presented at the LAck Standing Committee on state agencies on Thursday, January8,2026 where it was
deferred because of questions that the committee had related to other findings in that audit this audit will be presented again at today's state agency standing Committee meeting. this concludes my presentation. I'd be glad to answer questions at the appropriate time about legislative audit roll and medicaid. Representative dalby you're
Representative Carol Dalby
Unverified
12:41
recognized thank you madam chairir. just one quick question a couple of slides back there
there are too many what's right there that backup one no no no go forward one more that one right there the state's not established a medicaid recovery audit contractor program what did you say was our response because I was still wrapping my head around some of the other acronyms right there are the the the feds will grant an an exception for
Speaker 19
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that if you go through the appropriate process and request that and and that's what I believe the state has has
Speaker 47
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done as a as a result of that thank you thank you Mr Gazaway
the next item on the agenda is the overview and oversight of Arkansas Medicaid programme. This will include presentations from DHS Office of Medicaid inspector general and the attorney general's office. If staff other than those recognized to speak, please introduce yourselves for the record we will begin with the Department of Human Services of Secretary mann Arkansas Department of Human Services you are recognized.ive me one second
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in a minute you're gonna stay and drive right I'll be right over there. It should be easy
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has got to get reloaded. Inet went down just give me one second have it look at it. I'll have it up
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right back. Good morning Janet mannn, Secretary DHS
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good morninglourie Mcdonald chief of staff DHS. so I'll talk
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from the slides and uhlourri will drive. and we'll try to keep it to as close to 10 minutes as as we can so what is medicaid medicaid provides healthcare coverage to lowincome adults, children age blind and disabled and then we also do cover our expansion
group 8 of adults from 19 to64 yearold. it is a state and federal partnership and we work with the Cms as described earlier to have a state plan which is a governing document in addition to statutes and rules to govern that program. so for our delivery system medicaid delivery system can be done in several different ways of course Arkansas uses all three primarily we are a fee for service state which is we
cover programs and we pay when it is utilized using different codes and different prices managed care is a fixed member per monthly payment tomCOs. we then then they arrange and pay for the care we have a small managed care program which is actually an accountable care organization program using thepa program which we have4 MOs that govern that program unique to the state of Arkansas51% of those organizations have to be
owned by local providers instead of a large MCO program then the last option for medicaid delivery is something also unique to the state of Arkansas we're the only state that uses premium assistance which is how we govern and and purchase and serve the adult expansion population we go out to the insurance marketplace and we buy silver level premium policies for the expansion program
so quick overview of who we cover we cover approximately 1 in3 Arkansans in the state almost 1 in2 children currently we are have about 850,000 Arkansans enrolled in medicaid which is where we get the 1 in3 based on a3 million population we do cover50% of the irs in the state every year and we do cover 80% of the behavioral health services. We use fee for service for our core population s the managed care for our
highly complex and then as stated the premium assistance for the expansion then there's a breakdown of how we cover that 850,0an0 and the numbers for you
Speaker 64
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on the next slide which does show the majority of our population is covered by fee for service. Next slide
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breaks it down a little bit further for you to see our kids homeme A and B the medicare savings programme SsI arent caretaker several different of our large
population and then the numbers currently enrolled and we did pull this as of February 8th to to have the most current numbers Next slide shows a little bit on our annual eligibility limits majority of medicaid is determined by income levels in the number of people living in the household and then depending on different programs could have different requirements after income eligibility is determined. Long term care also has a medical determination for example
Next slide shows you the internal oversight mechanism at DHS we are a large agency there's approximately 9 divisions and all of these divisions do something that benefits medicaid so we wanted to give you some information on who does what DCO does our eligibilityddS is our developmental disability service OSam is our mental health and behavioral health dip squat is our license and certification just for examples. DMS division of medical Services
is covering the bulk of our fee for service population Next is the fun part everyone wants to know about our budget. So for Sy 26 we have approximately $9.7 billion budget as prescribed in our annual operating plan and here we have shown you how we think it will be divided up and spent by the end of the year. and then on the next couple of pages it just shows you what is covered in those different areas
broad categories institutional medical is inpatient outpatient hospital noninstitutional medical is an array of services from ambulances to FQHCs to lab and x ray to rural health clinics then you have your long term supports and services which does cover two waivers for independence and living choices hospice, nursing home personal care, private nursing facilities and pace. we do have two staterun facilities an
Arkansas nursing home and a psychiatric hospital or human development centers in this category apologies. Medicaid services for rehab inhab includes our autism waiver, our EiddT our AddT outpatient behavioral healthal, private duty nursing and pTOT in speech. and then our nonclaimbas payments this is my least fund category so these are where we pay our contracts we also pay for some programs but we also have an obligation in our state
plan with our dual eligibles which are eligibles that are eligible for Medicare and medicaid so we as the division of human services or department we will pay for thoseart A and B premiums we also pay for the state contribution of their prescription drugs which is commonly called the clawback forar D. that's why it's my least favorite
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because I don't get to choose if I pay those I just have to pay them. Umex category is our capitated payments which is where our home
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passed and the pCmH and our nonemergency transportation payments reside and then pharmacy is a standalone category that at473 million dollars473 million dollars a year and then I think our last category is supplemental payments so we pay supplemental payments based upon prescribed statutes and rules and state plan to different different types of facilities those can include provider fees to put up the state's share or be funded by the state.
Then we added a slide on changing the medicaid program there's been a lot of questions when we bring rules forward and how that is governed so a state I wanted to give you some information on a state plan amendment is primarily used for our fee for service program and a waiver request is actually a separate document which gives it waives some of our state plan requirements to serve a certain population in a certain way so we have a very specific waiver for a very specific
population that we're trying to serve. they differ state plan amendment can be retroactive for a couple of days up to 90 a waiver request cannot. those are the big differences that we always get lots of questions about and then I think to finish up we wanted to show you the Arkansas Medicaid providers. We have almost 118,000 Medicaid providers in the state and on this slide shows you where they are by county. and then we we I did include
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a slide on programme integrity but others are going to speak in detail on that. So I will
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conclude there thank you Mcdonald the next presentation try and pull well
Representative Carol Dalby
Unverified
23:03
it's not a question it's to the chair yes ma'am you're recognized madam chair can we have them as staff to send these out I would like to admit that I could see that those letters but I can't and so if you could please
have staff send this to us so we'll have that information thank you would that be possible? yes ma'am I think
Speaker 63
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we had provided it yes late yesterday afternoon so it should be available for y'all. thank you oh ok we'll get it
Speaker 14
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to you representative thank you Secretary ma'am the next presentation is
from the officefice of Medical inspector General Secretary Bragg and Samantha Blessingame, director of Office of Medicaid Inspector general you are recognized
Representative Wayne Long
Unverified
24:07
Thank you madam chair members of the committee, I'm Alison Bragg, secretary of the department of inspector general
Speaker 79
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and I'm Samanthalassingame director of the office of the medicaid inspector general. are you going to do that Ome's mission is to detect and prevent fraud waste and abuse in the medicaid program. we wanted to tell y'all a little bit about the history of Oeg
Speaker 80
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and how it came to be its own entity
as I mentioned I'm the secretary of the department and so the department of inspector general is where Oigg the office of medicaid inspector general is housed so sometimes that can be confusing since those titles sound so similar butomic is an agency within that department and it became that it became its own entity in 2013 inni ial ly and Secretary mann had referenced the programme integrity function. there's a federal requirement that
medicaid maintains a program integrity function just for accountability purposes until 2013 that was held within DHS in2013 the legislature moved that into its own independent entity and the statute that does that is listed there and then these bottom bullet points are parts of the statute that indicate why that was dones essentially to consolidate those prevention and recovery functions into one single and independent office where they could reorganize and
streamline those processes and that's what we continue to do today and then in 2019 of course with transformation rather than having so many separate agencies it became part of our department so our office does a
Speaker 79
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lot of things it really turns on our on whether we think somebody is stealing on purpose or they've made a mistake if we think somebody's stealing on purpose which we're going to figure that
out through audits data analysis and investigation we stopped there and we gather the evidence that we have and we refer the case to the attorney general's office or another law enforcement agency to see if criminal charges will be appropriate and we also at that point make sure and stop payments to that medicaid provider while that investigation is ongoing and we call that suspension we also then if we think it was just a mistake or and education issue we will go ahead
and take that money back from the provider that was paid improperly and will educate them so that doesn't happen again we just get that money back in the state's bank account and then the last thing we do when we see trends we will recommend to DHS potential policy changes or rule changes for their consideration this is a snapshot of the tangible
Speaker 80
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results that Omeg is able to produce and we've
included the last four years prior to now and as you can see in 2022 there is that number there 840,000 and then in 2023 obviously there was an administration change and a large scale staff change all across Oeg and that is where we started to leverage existing contracts with DHS relationships with vendors and we're really able to util ize those resources we did not increase staff in fact I think we have fewer staff than we had in 2022 and we're able to really
double down on the resources available to us and increase those efficiencies I was able to join the department in 2023 and then shortly after that director blastingame came on and really amplified our ability to identify funds for recovery and that results in this much larger number almost 10 times what we were recovering in the beginning so some of the common issues that we see
Speaker 79
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several of them are just like physical
impossibilities so somebody is in two places at once for example is what the billing shows or a beneficiaries is receiving supposedly receiving services at the same time which is rarely ok we also see things like impossible days so like a a provider billing 24 hours in a day 25 hours in a day 16 hours in a day there's an impossible situation under the the rules we see a lot of issues with background checks not being run
and then of course a lot of missing documentation and then also up coding which is just a provider a provider saying that they are doing something that's a little bit more complicated than what they're actually doing so they can get more money for that Secretary mann mentioned this and I'm sure you'll
Representative Wayne Long
Unverified
29:08
hear it after we speak as well but we are not completely independent. we work together with other agencies both state and federal
Speaker 80
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and we're excited about that we're happy to be able to have those partnerships those include obviously the Department of Human Services our friends at the Arkansas attorney general's office, I noticed that Mafuku got a good laugh out of everybody so that's one of everyone's favorite acronyms but we work very closely with them as well as some federal agencies as well that are listed here We also issue quarterly reports as well as an annual report and those are available online at our website which is igg.arkansas.gov and that reflects those numbers that you
saw earlier as well as a lot more granular detail of how we arrived at those numbers that concludes what we have to present to you all today and we look forward to any questions that you have later in the hearing. Thank
you Secretary Bragg and director of lassingame. the next presentation is from the attorney general's office Justin Brasher senior assistant attorney general and Tammyharrelson deputy attorney general medicaid fraud unit. you were both recognized.
Justin Brasher
Unverified
30:22
should do it for you OK thank you good morning madam chair thank
Jein Brasher
Unverified
30:30
you very much for having us my name is Jein Brasher senior assistant attorney general with the AG's office. I have Tammy Harrelson with me she's the deputy in charge of our medicaid fraud control unit or Mafuku and third time and I still got a little bit a little bit of a laugh that's awesome and so we're just going to talk a little bit about what our office does in relation to Medicaid, particularly with the fraud
Representative Carol Dalby
Unverified
30:59
morning thank you for having us Mafoku as we are affectionately known is the organization that actually prosecutes criminally Medicaid fraud we also are able to prosecute civilly if they we decide after an investigation that there is insufficient evidence to prove criminal intent and so then we'll just bring a money judgment against the providers the Mafuku
only is able to prosecute Medicaid providers we do not do beneficiaries CmS provides75% of our funding and so we are obviously bound to some of the federal regulations and those regulations have broadened our abilities over the years we now can also prosecute neglect and long term care
facilities we can prosecute abuse in long term care facilities. These include the any sort of nursing home, any boarding care facility we also are able to do exploitation so if you have your grandmother that is in a nursing home and she is being exploited either by a caregiver there or by a family member we are able to go in and do those there has to be a medicaid nexus somewhere
either she's a medicaid beneficiary or the home in which she is living actually is paid by Medicaid so our authority has expanded in the past few years and we're excited to be able to do a lot with that we are the end of the road as far as the medicaid fraud train goes we work very closely with DHS and with the the inspector general's office
and OI. we work with uhd uhddFNA we work with federal partners such as DEA we work with the FBI we work closely with the US attorney's office because they have similar very similar laws to what we do more than anything we have been proud of some of the stats that we have where y'all we sent them out yesterday madam chairir did were those included in the
Speaker 98
33:26
packets I think we they're on the slide I think if we get a slide yeah they were included in the packet as well even better you'll see the first chart on the
Representative Carol Dalby
Unverified
33:42
left hand side at the top. these are the investigations that we have actually opened this past year as you'll see it's it runs around about 100 every year this has increased from the last administration the blue is the criminal and then the gold or the civil
investigations we have really pushed trying to add additional civil investigations and so we've been able to get those up they were lower than that in 2022 but we're running about56 a year now in civil and about 103 on criminal. This does not include we have another 250 cases that are out there that we monitor at any one time or we're providing data to the feds so this is not just our entire
workload the criminal restitution and costs and fines are on the right. These generally stay low unless we have a big provider. A lot of our cases are somewhere around the5,000 dollars range,10,000 dollars but occasionally we'll get those that are much much higher this one from 2025 a lot of this was the Schwartz case the nursing home owner that
agreed to pay to repay the state over a million dollars and then at the bottom you've got the actual restitution that we have brought in as well as the costs and fees the blue is the criminal and the goat is the silver I mean it's the silver this year we've started well it's middle of February and we have had a million dollar verdict and so we're doing well there. and then just to make
Jein Brasher
Unverified
35:32
sure that we clarify so what we're talking about in terms of the criminal restitution
Speaker 96
35:36
and costs that right hand graphic that's what's been a court has awarded us is not necessarily what we have collected right those are two different things yeah something that you probably
Speaker 98
35:48
need to know a lot of people don't realize about us is that general we don't keep the
Representative Carol Dalby
Unverified
35:54
attorney general's office doesn't keep this money this money goes right back into the Medicaid programmerust fun.
the federal yes the federal government actually then gets the FMAP part of it which would be about70% right now and then the state medicaid program actually gets to keep the other30% so it goes out of the it goes right through the attorney general's office right back into the coffers so I think that's all we got right here we go
These are the criminal actions and civil actions that we have actually filed we've had a real push to make sure that we file as many criminal actions as we can the average most years prior to this were somewhere around 16 they had one really good year but the average was about 16 and that's what it was when this administration came in
at 2023 but we've had a real push to go forward from there we've had more actions coming in morere investigations coming in than normal and we've been able to investigate those and make good on them the civil actions are low most of these are are quitams or whistleblower cases we've always said that if we the more civil cases that we actually have filed you're doing better the fewer that you
can file. So if you can get them settled ahead of time that's what we aim for and all of the restitution that you see from last year in civil actions those were strictly from settlements and so what we try to do is do the investigations on the front end so that when we approach the provider and say hey you've got a problem they'll go ahead and pay and 99% of the time that's exactly what happens so we're pleased with that could you briefly just explain
Jein Brasher
Unverified
38:03
what our relationship is like with local
Speaker 96
38:06
prosecutor's offices in terms of doing these criminal actions so generally we don't
Speaker 98
38:10
have our own authority to go into a to a district and file a
Representative Carol Dalby
Unverified
38:16
criminal or civil action well we could pro crim civil but not criminal we have to go to each local prosecutor and so we have worked out agreements with many of those and they will appoint us as special deputies Medicaid fraud is a very different bird to try to prosecute
one of my prosecutors was there for 26 years at the Play County Pro prosecutor's office. I was there myself for about6 years and so it's it's a little different from just a regular murder it's different from a regular assault and so usually the prosecutors are happy to have us handle these we also have a prosecutor that worked at a human development center for 10 years and so she does most of the abuse
in the institutions and so the prosecutors are happy to have her come in and handle those cases
Jein Brasher
Unverified
39:15
so so yeah as I'm sure a lot of y'all are aware so the attorney general's office does not have its
Speaker 96
39:22
own prosecuting authority we have to be appointed as a special prosecutor in any case to prosecute a case to file charges and so that's what we are generally appointed by the elected prosecutors sometimes by the court or a judge will also do that and I believe that's that concludes our presentation and we're happy to take any
questions when the chair is ready for us to take them. Yes
excuse me thank you Mr. Brasher and M Harreson committee you've heard all the presentations are there any questions for staff or representatives of these offices
Speaker 41
39:50
Representativealby you're recognized thank you thank you madam chairir
Representative Carol Dalby
Unverified
39:53
I think you at the very end answered my questions are these mostly being filed in state court or do you go to federal court? The civil actions are often filed in federal court because they're w hi
s tle b low er actions key tams but all of the criminal
actions almost all are filed criminally occasionally we will file something in federal court if we are working with the US attorney's office and in follow up and I think you
answered my question because I've been writing questions down that came to me so you're filing them in the
jurisdiction where that provider is located medicaid fraud I'm sorry no no no go ahead that fraud cases are always filed in Pulaski County. OK,
Speaker 115
40:37
I wondered about that yes and and the judges here
Representative Carol Dalby
Unverified
40:42
they're familiar with the cases they know how they work if it is an abuse and neglect or exploitation it is generally found where either the defendant is or the actual institution or the victim is ok and I think most of y'all know I live inexarkana
and you know go across the state line and you're gonna have medicaid folks provide r s over there yes and so what do you do in that case and I mean you we're gonna have west
memphis memphis you know the outlying areas are you able to cross that state line
or is that when you're going to the federal prosecutor fed the feds to do that
Speaker 98
41:25
generally if they so let's say we've got a doctor that
Representative Carol Dalby
Unverified
41:29
is inexarkana or just over the line actually lives in Texas but if he is providing Medicaid services to Arkansas beneficiaries then we can go ahead and we will actually file it in Arkansas occasionally
we've had to reach out to say Texas or Tennessee, Oklahoma we do that regularly if we need to and we'll work together with them to determine the best place to file a case. OK great thank you thank youpresentativepresentative Brown you're recognized thank you madam chair on the the civil actions
Representative Matt Brown
Unverified
42:01
that y'all file is the provider is there some mechanism where they like suspended from being a provider when you have to sue them or are they able to still be a provider and if they are is there some mechanism that you're able to
like set off against payments maybe they're legit to collect for the ones that were not legitimate
Speaker 109
42:21
just how does that work? generally in civil cases we don't suspend we
Representative Carol Dalby
Unverified
42:26
can't suspend anyway we got to omig for that but we don't suspend in civil cases there is a mechanism where we can go through the court and ask that either the anything that they received gets
set aside and held say or but generally we don't do suspensions for civil cases madamir you recognized do y'all have any idea and it's kind of unfair I'm assuming that would probably be some sort of a
Representative Matt Brown
Unverified
42:58
federal requirement that would change that like we probably couldn't do it at the state level it just seems to me like if you catch somebody you know committing fraud you know you turn off the spigot immediately but I'm assuming we probably can't do it at the state level Actually I think that there are ways that we could do that and I'd like to be
Speaker 98
43:15
able to talk with you at some point if you'd like to go forward with that all right
Senator Jim Petty
Unverified
43:26
thank you madam chair Senator Petty you're recognized thank you madamir. I've got a couple of comments and then my question is going to be for the office of inspector general so just a general comment and and listening to what the attorney general's office and especially with the office of inspector general and and OIG do it it it to me at least it makes sense why this committee
is not necessarily meeting regularly because we we have a lot of concerns about fraud in general and and the inspector general has has been doing that as well as the attorney general. second it appears that unlike some of the other states across the country that we have a pretty good handle on fraud. doesn't seem to be at least identified at this point a large number which is encouraging
for us as as legislators but also the taxpayers and then finally for the office inspector general there were it went from 800,000 to to to several million dollars and if I remember the slide right it was like identified for potential recapture can you can you expand on that slide just a little bit and what what you mean by that and and kind of what those numbers in actual recoupment
or or potential recruitment just kind of expand on that just a little bit moreer and
Speaker 80
44:52
director of blasting gave and that went over this yesterday preparing to visit with you all about how much detail to give on that proactively before you ask that question and in order to keep it under 10 minutes we eliminated a lot of that but I'm so happy that you asked that because that's a really important part of identifying the recovery versus actually collecting those recoveries in our quarterly and annual report
s that are online we delineate those dollars and there is a separation between here's the amount that is identified to be recovered versus the amount that has been actually recovered for example if you were to look at our 2025 annual report or our most recent annual report you'll see that as two separate numbers the numbers on the slide today were the dollars identified for recovery that felt simpler and cleaner to explain from a bird's eye view we can
certainly get you as granular as you would like they're on our website and we're happy to send them to you as well the difference year to year is usually just a matter of chronology so we might identify a lot of money in November December and then we start excuse me we start trying to recover that and then maybe that's not paid back into the medicaid system until the following calendar year or the following fiscal year so it might be reported in the next year ' s totals so those numbers will
Speaker 88
46:18
never be entirely congruent but we're always pursuing those dollars that have been identified. follow up madam you
Senator Jim Petty
Unverified
46:24
recognized so just just one more clarification so at the point it goes on the list as identified for you know potential at that point it has been determined that it is a fraud or a mistake and then you've move it's not we've identified some potential here and and then we've got to investigate some more oncece it gets on that list it is public funds at risks that you're going to work to recover. OK thank you
that's right thank you Representative Long
Representative Wayne Long
Unverified
46:55
you're recognized thank you madam chairman. earlier it was brought up that I believe that by the ag's office that y'all prosecute I guess institutions that are committing fraud. I was wondering could somebody address is there anybody that is authorized to investigate and and prosecute individuals recipients that are committing fraud reason I ask you know
around towns sometimes you see these signs up it says like we buy test medical testing equipment or medical supplies that type of thing which I would think is probably coming from Medicaid so somebody's obviously getting these things for free and selling them to someone I was wondering if we actively investigate those thank you yes sir the question that you're identifying is the difference between provider
fraud which is the focus that you've heard a lot about today versus beneficiary fraud which has come
Speaker 80
47:52
up but perhaps not in as much detail. We have the ability to investigate that there's also a component of DHS that works on that we saw a slide from Secretary mann that talked about their division of county operations and how that focuses on eligibility, beneficiary eligibility. our statute that our estab li sh ing statute does authorize us to do that we sort of have a friendly agreement with DHS that a unit of theirs payment integrity handles beneficiary fraud to the extent that they're
able to work on that they do that and we focus our efforts and our resources on provider fraud as you can imagine there is some overlap there and that's why we do maintain that relationship and a close working relationship with that unit and with the department as a whole from a prosecution standpoint as you know neither we nor DHS are a prosecutorial body so if there were a beneficiary fraud that rose to that level that would probably be be referred to the appropriate county prosecutor to handle from there any idea how
Representative Wayne Long
Unverified
48:55
many individuals were prosecuted in I guess the last fiscal year on beneficiary fraud I wouldn't be able to we're
Speaker 80
49:01
not related to those prosecutions so I'm sorry I wouldn't have that information but we can probably point you in the right direction maybe someone at DHS would be able to get you that I appreciate it thank you yes sir Representative
Representative Carol Dalby
Unverified
49:13
dalby you're recognized thank you thank you madam chairir excuse me Secretary Brag how many how many attorneys I'm just curious how many attorneys are in your office
I mean because you you obviously got to have somebody that's overseeing it you're
Speaker 80
49:31
not you're not doing it necessarily. Director Blasingame is where the buck stops so the buck stops with me because I need to be responsible but she is the director of the Oigg unit. she is also an attorney. we have one other attorney on staff dedicated to OIGg and then we have a shared services attorney that can help as needed and I forget this sometimes but I'm also an attorney so we have4 well let's hopefully you've paid
Representative Carol Dalby
Unverified
49:56
your bar dues and all that good stuff OKok and and they just handed us the stuff so we could see it and I I noticed that in one of the things that y'all are in charge of and I've already lost the page but basically for suspending providers or drop them have you have you aggressively done that for people who are frequent flyers through your office and do you have an idea of how many providers you your
office has suspendedertainly the number is definitely
Speaker 80
50:30
in our annual report and in our quarterly report it's director blasting gave me and tell me where do we find that
Representative Carol Dalby
Unverified
50:36
online because I didn't know your annual report was online yes it's at igg.arkansas.gov and there is a button for
Speaker 80
50:43
omig that has a little picture and you can click on it and then it just has them listed under reports and I'll also be happy to email you link. I can look it up.
Speaker 88
50:53
I just didn't know so that's where that
Speaker 80
50:58
number is found yes and you had mentioned frequent fliers we certainly do that for frequent flyers. Our standard for suspension is what's called a credible allegation of fraud so I came from the US attorney's office and my barometer for thinking about that is always probable cause is it more likely than not? Are there indicators here that this is a probable an allegation a credible allegation of fraud and once that happens we can suspend whether or not they are a frequent flyer we can also lift that suspension if we
hand that off to the attorney general's office and they determined that it doesn't rise to that level we can lift that suspension but we always want to act as quickly as we can to preserve and protect those government dollars because they don't need to be going into a situation where there is fraud involved and so we can and do turn off that spigot as quickly as we can one other question
Speaker 144
51:49
you recognize I wrote a lot of questions it's great and this may
Representative Carol Dalby
Unverified
51:53
not fall to you this may fall to Secretary
mannn's department but y'all are all working interrelated anyway so you mentioned I believe it was in y'all's presentation you mentioned the education of these providers and are y'all responsible for educating these providers as to what they can or cannot do and if so you know what are the major issues in that education I believe it was y'all that mentioned that and so I'm just curious what is
that process let's just say uhpresentative Schultz here y'all flagged him you go talk to him and then do you say hey look this is an issue here's how you correct it or do you pass that on to DHS or somebody else I'm just curious because you know we all want to we all want to see it done but sometimes it's a lot easier to say somebody else will get in contact with you and then he never hears so I'm just curious as to that process when it's an issue that our office
Speaker 80
53:01
identifies we will do that corrective education and we'll do it while we're working with that provider on that audit. I know there's also front-end education for providers provided by DHS ours is more from the standpoint of the safety net. OKok here's a finding that you had in a medicaid audit from Oigg let's work with you on the mistake that was made there we we know it wasn't an intentional fraud situation we just want to help you understand the coding better, understand the billing
better and not make that mistake that results in that money going out again so we would step in at a corrective point once that mistake has been made as opposed to preemptive education which I believe DHS would provide. thank you thank you
Speaker 72
53:46
very much thank you madam chair you're welcome yes two questions
Senator Steve Crowell
Unverified
53:51
number one in that report that's monthly or we quarterly I would love to see the committee at least get that email to us because we know
it's there but we're going to forget and then when it pops in our email it'll be like we need to look at that and then this may not be for you just a thought process for me because we've got budgets coming up do we know what our new FMmapP number is gonna be is it gonna be worse better all right thank you are there any other questions from the committee
seeing no other questions, I'd like to thank the secretaries and directors for yes ma'am I have a question for Secretary mann. Secretary mann would you
come to the end of the table please? thank you Secretary Barack. it's a simple
Representative Carol Dalby
Unverified
54:50
question from a simple mind so my question is a number of years well sessions ago I've kind of forgotten when it was but we passed our home and and that and that
that deals with with these providers and medicaid and get help getting people off that program. how's that working? I'm just curious because I don't sit in any of those committees and I haven't heard
any reports as to how our home oh that may not be what we're calling it now I don't know but you know what I'm talking about Janet
Speaker 63
55:22
I believe so So expansion population is called our homeme currently and we are working towards community engagement slash work requirements which is I believe what you were referring to
with the passage of hr one those are to be implemented by January 1 with with work requirements we are working rapidly through that process we plan to launch softly live on July 1 with no punitive but mainly education working with providers working with beneficiaries working with the community of here is the new programme, here's how it will look what going all the way up
to that process except if you don't fulfill this we will be terminating your coverage on January 1 that will change and then new applicants will have to have a period of community engagement to become el ig ible and then we will be doing redeterminations on group 8 or the expansion every six months of which they will then have to meet that requirement is that what you were asking it is it's just that this is outside of any committee I ever sit on
Representative Carol Dalby
Unverified
56:37
to hear your updates and I was just curious so I
appreciate that very much thank you yes ma'am thank you Secretary mann before you go umpresentative Long asked a question about beneficiaries that were fraudulent can you address that at
Speaker 63
56:52
all yes ma'am I can thank you so within DHS and DCco and then security and compliance we have a unit that focuses on beneficiary investigations and we handle those for Medicaid andsnap when those are
identified they are referred to the local prosec prosecutors for prosecution and do you have a feel for how many you see coming
Speaker 112
57:15
through? No ma'am we did to see what they were we
Speaker 63
57:19
did see an uptick as reported from legislative audit on Dsnap but outside of those numbers I don't have an updated number but we're
Speaker 64
57:25
more than happy to have it pulled. OK, I'd appreciate that thank you yes ma'am any other questions all
Speaker 14
57:31
right committee again thank you to each of the secretaries and
directors for being here today. I really appreciate just
the information that you shared and a committee you should have a copy of all the slides that were shared and I look forward to seeing you next time meetingeting adjourned
Agenda
A. Call to order by Chairman.
B. Adoption of the minutes of the November 1, 2018 meeting.
C. Overview of Medicaid Subcommittee 1. History of Medicaid Subcommittee 2. Legislative Audit’s role related to Medicaid
D. Overview and Oversight of Arkansas Medicaid Program 1. Department of Human Services 2. Department of Inspector General – Office of Medicaid Inspector General 3. Office of the Attorney General
E. Other Business.
F. New Business.
G. Adjournment.
500 WOODLANE ST., STE. 172 • LITTLE ROCK, ARKANSAS 72201-1099 • PHONE: (501) 683-8600 • FAX: (501) 683-8605 www.arklegaudit.gov
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — LEGISLATIVE JOINT AUDITING-MEDICAID SUBCOMMITTEE, Feb 12, 2026 | Agenda | 1 | Official source ↗ |
Speakers
Representative Mindy McAlindon Chair
Unverified
Speaker 3
Representative DeAnn Vaught
Unverified
Speaker 13
Speaker 19
Speaker 35
Speaker 38
Speaker 23
Representative Carol Dalby
Unverified
Speaker 47
Speaker 54
Speaker 56
Speaker 29
Speaker 60
Speaker 62
Speaker 63
Speaker 64
Speaker 70
Speaker 71
Speaker 14
Representative Wayne Long
Unverified
Speaker 79
Speaker 80
Justin Brasher
Unverified
Jein Brasher
Unverified
Speaker 96
Speaker 95
Speaker 98
Speaker 41
Speaker 115
Representative Matt Brown
Unverified
Speaker 109
Senator Jim Petty
Unverified
Speaker 88
Speaker 144
Speaker 72
Senator Steve Crowell
Unverified
Speaker 112