MS may be paying out fraudulent Medicaid benefits

MM Curator summary

A new audit in MS shows members are getting enrolled even when they are ineligible due to higher incomes.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


As part of its Single Audit Report for the 2020 fiscal year, the Mississippi auditor’s office sampled 180 Medicaid beneficiaries and found that nine of them were ineligible due to the high income reported on their state tax returns.

On average, those nine reported income levels $10,727 above the threshold for Medicaid enrollment.

In addition to the nine individuals flagged in the sample, two people who own multi-million dollar homes and declared high incomes on their tax returns, despite receiving Medicaid benefits, had already been flagged as potential fraud cases to investigate. 

Under current state law, the Mississippi Division of Medicaid does not have the legal authority to obtain state income tax returns to compare them with the income declared by a person applying for Medicaid benefits. State Auditor Shad White is now calling on Gov. Tate Reeves and the Legislature to grant this authority so that potential fraud can be prevented on the front end. 

“I stand ready to work with Medicaid’s leadership to argue to lawmakers that they should have this tool in their toolbox,” White said in a press release. “It could stop ineligible applicants from being put on the program in the first place. We know this tool would be useful because Medicaid’s internal policies state they should ask an applicant for their return, but without the authority to get the return and a requirement to use it, the state is potentially handing out millions to ineligible people.”

In a statement, the Mississippi Division of Medicaid (DOM) said it does not agree that the use of state tax returns would help root out fraud, as the tax information used by the auditor’s office in this case is from more than a year before the person applied for Medicaid. DOM is required to base eligibility on current income and noted that “financial information that far out of date may not accurately reflect the current circumstances of applicants.”

In June 2019, the most recent month for which figures are available, 673,247 Mississippians were enrolled in Medicaid.

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