Legislative Auditor to Speak to Congressional Subcommittees on Need for Medicaid Audit Changes

Legislative Auditor Daryl Purpera announced today that he will testify on Thursday before a rescheduled congressional subcommittee hearing about improper Medicaid payments in the states. The hearing had been scheduled for March 21 but was cancelled because of weather.

Purpera will talk about the need for changes in the way state auditors audit Medicaid. The goal of the changes, he said, is to strengthen efforts to reduce fraud, waste, and abuse in the program.

The hearing will focus on what steps state and federal officials are taking to identify, prevent, and recover improper Medicaid payments, as well as the federal-state relationship in terms of Medicaid data-sharing quality, and identifying and preventing fraud.

Specifically, Purpera will discuss the Centers for Medicare and Medicaid Services’ inadequate audit requirements, state auditors’ lack of access to federal tax data, the costly effect of the federal reasonable compatibility standard, and the need for a new approach to auditing the Medicaid program.

The problems of inadequate audit requirements, lack of access to federal tax information, and the reasonable compatibility standard are related to auditors’ inability to ensure Medicaid recipients meet the program’s income requirements. Under current guidelines, auditors are not able to evaluate whether Medicaid programs are effectively monitoring recipients’ eligibility and thus whether they are paying out more benefits than they should.

In his testimony, Purpera also will stress the importance of creating a national, collaborative framework for auditing Medicaid and of the federal government providing funding for such an approach. The new approach would build on infrastructure that already exists in many states, including an increased use of data analytics and of multiple state data sources to evaluate processes for determining Medicaid eligibility.

Purpera will appear before the Joint Meeting of the Subcommittee on Government Operations & the Subcommittee on Intergovernmental Affairs at 9 a.m. Central time on Thursday, April 12. The meeting can be viewed when it starts at https://oversight.house.gov/hearing/improper-payments-state-administered-programs-medicaid/.