CHEYENNE - Wyoming's Medicaid Fraud Control Unit is looking for more business.

But the agency cannot go shopping for cases of fraudulent Medicaid claims and instead must depend on outside referrals.

"We're not getting the number of referrals we would like to have," said Christine Cox, the unit's new executive director. "I don't know if people know we exist."

The unit has identified slightly more than $2 million in Medicaid overpayments for calendar years 2007 and 2008. So far this year, it has identified about $1 million.

Given national estimates on the scope of Medicaid fraud, the amount could be as much as $30 million a year, Cox said.

That chunk of money would help the state's Medicaid budget, which is strained by a $100 million increase in payments this year alone. Nearly half the total comes from the state's General Fund. The rest is federal money.

The jump in costs for the medical program for low-income adults and children is because of a caseload that has grown by 3,500 people to 74,000.

The bump came in the wake of the state's rising unemployment rate, which, at 6.5 percent, is now the highest in two decades.

Congress required all states to have Medicaid Fraud Control Units in 1993.

Wyoming's unit started operation on Jan. 1, 1995, as a division of the attorney general's office.

The Wyoming unit is 75 percent federally funded with the rest coming from the state's general fund.

In addition to Cox, the unit has an auditor, an investigator and a paralegal office manager.

Cox would like to add a health professional to the staff.

Dan Neal, executive director of the Equality State Policy Center, said the state would be wise to invest in an excellent Medicaid fraud team.

He suggested that the $30 million a year loss to Medicaid fraud may be low, given national estimates of a 10 percent loss to fraud on program payments.

Full story