WV may have paid $32M in Medicaid to ineligible people, including some who are dead

The state is working to recover up to $32.4 million after it came to light that it may have mistakenly paid Medicaid participant fees for thousands of ineligible individuals who were incarcerated or dead, a new audit revealed.

West Virginia uses managed care organizations to administer Medicaid services for most of the state’s Medicaid users and pays per enrollee. Most inmates are not eligible to receive Medicaid under federal guidelines, yet from 2019 to 2022, the state’s Bureau of Medical Services potentially overpaid those MCOs for 117,447 cases of incarcerated individuals — approximately $31.7 million in capitation payments.

The state also may have overpaid the organizations for 15,346 cases involving deceased people, approximately $770,000 in capitation payments.

The audit of the