BURLINGTON, Vt. (WCAX) – The Department of Vermont Health Access’s efforts to stop fraud is reported to have fallen short of its duties.
Auditor Doug Hoffer’s team found the Department of Vermont Health Access special investigative unit identified $1.2 million of improper payments in just a sample of 2024′s claims.
The auditor says in most of these cases, the special investigative unit was able to retrieve the erroneous payments. However, $517,000 will not be recovered due to what they say is the Department of Vermont Health Access’s management problem.
According to the report, Medicaid-related expenditures totaled over $2 billion last year, and the program had a caseload of 197,000 people. Auditor Hoffer says that because of its size, scope, and complexity, Medicaid is vulnerable to fraud, waste, and abuse.
“The Department of Vermont Health Access and partner State organizations did not consistently act in response to Special Investigative Unit-identified findings, vulnerabilities, and policy concerns, thereby putting Medicaid funds at risk,” said Hoffer in a recent statement
Now, it’s up to the Department of Vermont Health Access to implement recommendations from the auditor’s office to prevent more fraud and taxpayer money from being lost.
The auditor’s office’s main recommendation is for the Department of Vermont Health Access to address vulnerabilities once the special investigative unit finds a gap.
