Maryland lawmakers press health officials over millions in questionable Medicaid payments

BALTIMORE (WBFF) — Maryland lawmakers pressed state health officials Wednesday over millions of dollars in questionable Medicaid payments and other repeat problems flagged by state auditors, including claims tied to people who were incarcerated or already dead.

The scrutiny came during a lengthy hearing in Annapolis focused on a 66-page audit of Maryland’s Medicaid program. For the second consecutive audit, the Office of Legislative Audits gave the program an “unsatisfactory” rating.

“This is the second time that the audit has been deemed unsatisfactory,” Legislative Auditor Brian Cannon told lawmakers.

Of the 12 findings identified in the latest audit, six were repeat findings that had been raised in previous audits — a point that drew frustration from members of the committee.

“These to me are, they’re embarrassing for the department to come in with repeat findings of this magnitude,” Del. Steven Arentz said during the hearing.

Among the most significant findings, auditors identified $6.4 million in Medicaid payments associated with roughly 2,400 incarcerated recipients. About 1,000 of those recipients had also been identified during the previous audit.

Auditors also identified another $2.8 million in claims for services reportedly provided after recipients had died.

“We keep seeing the same thing every audit,” Arentz said, “We aren’t managing money. We’re not following up. We’re not doing certain things that a department should be doing. Do you have any idea or any explanation on how this continues to happen?”

State health officials pushed back on the suggestion that all of the money identified by auditors represented improper payments.

According to the Maryland Department of Health, approximately 75% of the claims involving incarcerated recipients were allowable inpatient claims. The department said it is still investigating approximately $1.5 million in claims to determine whether payments were improper.

That explanation prompted additional questions from lawmakers about the discrepancy between the auditors’ findings and the department’s assessment.

“There’s just a big gap there between what you’re contending and what they’ve contended, and I’m not sure we’re understanding why that discrepancy occurred,” Sen. Clarence Lam said.

When Lam asked whether the department intends to recover money in cases where payments were determined to be inappropriate, officials said yes.

The audit also found problems extending beyond questionable payments.

Auditors identified hundreds of plans for Medicaid recipients receiving home and community-based services that had remained unapproved for more than 15 days. In some cases, the plans remained unresolved for months or even years.

According to the audit, those delays could result in recipients not receiving required services or the state continuing to pay for services that were no longer necessary.

Health officials told lawmakers the department has made significant progress since the period examined by auditors. According to the department, eight of the audit’s 12 findings have now been corrected, while the remaining four are expected to be fully addressed by the end of 2026 or 2027.

But lawmakers questioned whether those assurances were enough given the number of repeat findings.

“I appreciate that, but, and I don’t mean this disrespectfully, we probably heard that in the last audit, that we are addressing these things, we’re doing these things,” Arentz said.

A department official responded that ensuring taxpayer dollars are properly managed remains a priority.