WV AG’s Office Will Begin Investigating CHIP Fraud

December 1, 2022

Mountaineer News

West Virginia AG

CHARLESTON - The West Virginia attorney general’s office received approval from the federal government to investigate fraud in children’s health insurance programs, such as CHIP, Attorney General Patrick Morrisey announced.

The office will investigate fraud in these programs through its existing Medicaid Fraud Control Unit. When fraud unit workers are investigating other fraud claims, they will now be allowed to expand their investigations to determine whether residents are fraudulently receiving money through the children’s programs.

Nearly $49 million is spent on CHIP annually in West Virginia.

“If you were to think that there’s a couple percentage points of fraud, that means there’s a few million dollars out there that probably shouldn’t be spent,” Morrisey said during a news conference. “So why not add that to the mix? And so if we see it now in the context of our other investigations, we’ll be able to go after it.”

The attorney general also gave an update on how the fraud unit has functioned since the office took control of the unit in 2019. Previously, the unit was under the authority of the Department of Health and Human Resources.

Over the last three years, the attorney general’s office expanded the unit from 12 workers to 21 workers. The unit collected about $25 million in civil recoveries annually since the attorney general’s office took over, which was a 180% increase from the previous three years the unit was under DHHR’s authority.

When those two periods are compared, annual new fraud cases opened increased by 233%, annual fraud cases closed increased by 42% and annual abuse and neglect cases closed went up by 157%. New fraud referrals increased by more than 50% and abuse and neglect referrals went up by 220%. The attorney general’s office also saw higher numbers for prosecutions, convictions and overall investigations.

“We need to protect these programs for the beneficiaries: the people that rely upon them,” Morrisey said. “And we have to make sure the railroad is being run the right way. I’m committed to dedicating what it takes to ensure that fraud, waste and abuse … is rooted out in the state of West Virginia.”

The attorney general projects that the fraud unit will continue to grow in coming years and said there is still more work to be done.