The West Virginia Department of Health and Human Resources (DHHR) Medicaid Fraud Control Unit today announced the approval of a waiver that will allow it to conduct data mining activities designed to detect Medicaid fraud. The waiver was awarded by the U.S. Health and Human Services, Office of Inspector General.
“This waiver allows DHHR’s Medicaid Fraud Control Unit to proactively evaluate Medicaid claims using data analytics and statistical modeling to uncover patterns and activities that may be indicative of fraud,” said DHHR Inspector General Kathy Lawson. “Without a waiver, state Medicaid Fraud Control Units are prohibited from using federal matching funds for such activities and instead must rely on referrals from other sources.”
West Virginia joins only nine other states that have successfully obtained the waiver from the U.S. Health and Human Services, Office of Inspector General. Funding for these data mining activities will come largely from federal matching funds.
The Medicaid Fraud Control Unit, through DHHR’s Office of Inspector General, investigates and prosecutes or refers for prosecution allegations of health care fraud committed against the Medicaid program and allegations of the criminal abuse, neglect or financial exploitation of patients in Medicaid-funded facilities and residents in board and care facilities. Additionally, the Medicaid Fraud Control Unit is responsible for investigating fraud in the administration of the Medicaid program. Its mission is to protect West Virginia’s vulnerable residents and the integrity of its health care programs.
To report Medicaid provider fraud or patient abuse, neglect or financial exploitation, please call 1-304-558-1858 or toll-free at 1-888-FRAUD-WV (1-888-372-8398).