Study: Medicaid gave out $11.1M in ‘potentially inappropriate payments’

DOVER — An outside contractor tasked with identifying possible waste and fraud in Delaware’s Medicaid has singled out $11.1 million in “potentially inappropriate payments” made over a period of about three-and-a-half years.

Those payments could come from doctor shopping, in-patient services that should have been billed as outpatient, and care that is not medically necessary.

The General Assembly directed the Department of Health and Social Services (DHSS) in 2014 to work to save money in health care after the legislature’s Joint Finance Committee members stated their belief that $12 million could be saved annually.

After a delay, which irked lawmakers, DHSS commissioned Health Integrity in March to examine potential patient and provider misuse of services in Medicaid.

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