Medicaid fraud costing PA millions of dollars says Attorney General Josh Shapiro

HARRISBURG, Pa. -- Pennsylvania Attorney General Josh Shapiro says Medicaid fraud is costing the state millions of dollars.

That includes unlawful billing and caregivers failing to provide services.

According to the Attorney General, more than 2.7 million Pennsylvanians are covered by Medicaid; that's roughly 21% of the state's entire population.

That number includes people who don't make much money and children who are suffering from serious health conditions.

"It's an issue all Pennsylvanians should care about both from a fiscal perspective and a humane perspective," said Shapiro.

Shapiro says, bottom line, Medicaid fraud hurts people's wallets.

"When dollars are defrauded from the system, it means our taxes go up or we have to cover the shortfall," he said.

A state-wide grand jury investigation into the system stemmed from two cases.

"There was a young autistic girl who didn't get help because her mom wanted her house to be painted or wanted errands run. This is unacceptable. There's a human toll to that, and that's the little girl not getting the help she needs," he added.

Throughout its course, the jurors identified a number of flaws in the system and three recommendations to help.

  • A new way to identify individuals providing services in Medicaid claims called a state provider identifier
  • All claims should require specific dates and times of the service provided.
  • Mandated standardized training for all individuals providing services

"We needed added tools in order to be able to do our jobs," added Shapiro. "We think it's time, the grand jurors think it's time that lawmakers pass these additional reforms and make sure we can better protect Pennsylvanians and taxpayer interests."

Shapiro's hope is that lawmakers will soon begin drafting legislation that could one day make the recommendations law.

He claims it will lead to more convictions and save the state and taxpayers money.

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