End of Year Report Why was the request made Bent Crowley and Huerfano Counties do not have the expertise or resources to adequately investigate member fraud and settle these cases through repayment agreements or criminalcivil court ID: 743781
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Bent CountyRegional Fraud Investigator
End of Year ReportSlide2
Why was the request made:
Bent, Crowley, and Huerfano Counties do not have the expertise or resources to adequately investigate member fraud and settle these cases through repayment agreements or criminal/civil court.
It was determined that these counties could be served by hiring a dedicated fraud investigator who could give the attention that was needed to the suspected fraud investigations. Slide3
Outcomes:
$200,272.00 in claims have been established on 7 of the 12 cases. No further action on the rest.
In addition, Bent County has concluded a case that has been in court, prior to the grant period, for the amount of 100,000.00.
Twelve investigations of Medicaid Fraud were completed to date:
Bent County is currently pursuing two additional member fraud cases in the amount of 34,456.00.Slide4
Lessons Learned:
Communication among three counties is difficult.
Tracking cases and working with an investigator not housed in county building is difficult.
District Attorney is not “a happy participant” in these matters.
Cases are slow to move when there is not enough resources to complete all of the tasks associated with completing the case.
Eligibility Technicians lack the experience and confidence in interviews to prevent up-front fraud. Slide5
PEAK self-employment cases contribute to a fair share of these member fraud cases. Slide6
Where do we go from here?
Bent County will continue to develop training resources for staff to increase confidence with interviewing skills, and increase knowledge and understanding of rules/regulations.
A local investigator is a must to increase communication and timely resolution of cases.Slide7
Budget
The regional contract was awarded $34,440.00.
By the end of the contract, it is likely that less than $10,000 will have
been expended.