According to a release from Kansas Attorney General Kris Kobach, the AG’s Office of the Inspector General has discovered nearly $800,000 in fraudulent Medicaid pregnancy coverage in the state.
The review identified 62 Medicaid beneficiaries aged 45 or older — out of 151 cases audited — who appear to have fraudulently enrolled in pregnancy-related coverage. These cases resulted in improper payments totaling more than $798,000.
According to the OIG report, an additional review was conducted for beneficiaries without pregnancy-related claims that were originally reviewed by the Investigations Team. From that review, the Audit Team determined that out of 151 beneficiaries, 32 (21%) were placed on the Pregnant Women program due to KDHE error and potential beneficiary fraud. Out of $798,620.97, approximately $137,615.95 was paid during the audit period, related to potential fraud combined with KDHE error.
Examples of the potential fraud include:
- The beneficiary applied for Pregnant Woman program coverage several times after her previous program coverage ended. No newborns were reported during the review.
- The beneficiary reported different estimated delivery dates (EDD) for her medical and non-medical cases. No newborn child was reported to Medicaid.
- The beneficiary had claims that were counter-indicative to pregnancy.
Out of 151 beneficiaries, 18 (12%) were placed on the Pregnant Woman program or received extended coverage through a reporting error made by the beneficiary. Beneficiary errors were assessed based on the beneficiary making a mistake during the application process or neglecting to inform Medicaid of changes that would affect their coverage. This could include a lack of reporting the birth or loss of a child.
Approximately $20,472.13 was paid to beneficiaries who were placed in the program or received extended coverage due to beneficiary error.
Another 10% were placed in the Pregnant Woman program or received extended coverage due to an error by KDHE. These errors could have occurred when processing the beneficiary’s application, extending the beneficiary’s coverage, or erroneously classifying the beneficiary as pregnant, totaling $19,797.95.
Our interim report included four recommendations intended to improve KDHE’s oversight of the program,” Kansas Inspector General Steven D. Anderson said. “If the recommended updates to policies are implemented, the state of Kansas would have saved approximately $280,000 in 2025.”
The OIG’s recommendations are:
- KDHE should develop policies for determining if an applicant’s self-attestation of pregnancy is consistent with the State’s information. Creating policies will assist KDHE employees with determining if an applicant’s self-attestation of pregnancy is questionable.
- KDHE should develop procedures for how eligibility staff are to proceed if they determine an applicant’s self-attestation of pregnancy is inconsistent with information already in the State’s possession. Developing procedures will assist KDHE employees with how to proceed if they conclude the pregnancy to be questionable, ultimately curtailing inaccurate eligibility determinations and inappropriate spending of State Medicaid funds.
- KDHE and MCOs should regularly review claims to ensure pregnant women are receiving prenatal care, to verify pregnancy, and prevent maternal and fetal comorbidities and risk of death.
- KDHE should establish a required routine for pregnancy and postpartum report reviews to ensure the timely discontinuance of Pregnant Woman program coverage.
The OIG is an independent division of the Kansas Attorney General’s Office. The Inspector General reports directly to the Attorney General, but — by state law — the scope, timing, and completion of all audits and investigations conducted by OIG is within the discretion of the Inspector General.
