Grand jury recommends changes to crack down on Medicaid fraud

Tony Romeo
April 15, 2019 - 5:52 pm
Attorney General Josh Shapiro

Tony Romeo/KYW Newsradio

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HARRISBURG, Pa. (KYW Newsradio) -- Attorney General Josh Shapiro has released a set of grand jury recommendations intended to identify and prevent fraud in Pennsylvania’s Medicaid program.

Shapiro says two independent Medicaid fraud investigations prompted a grand jury to investigate anti-fraud measures and ways to ensure quality care for recipients.

“What we see here today, yes, are unscrupulous actors,” he said. “But we are also here to identify that with these tools in place, with these legislative reforms in place, we think we can mitigate some of that loss and we can better protect Pennsylvanians.”

The recommendations include requiring those providing services paid in whole or in part with Medicaid funds to register with the state and be identified on all claims. They also recommend requiring all claims to document date and times of service, and to require standardized training.

Shapiro says right now, absent these recommended changes, the Department of Human Services is doing its best to limit fraud.