State Auditor’s office limited to investigations of Iowa Medicaid

While current state Auditor Mary Mosiman wrapped up an investigation into the savings of Iowa’s Medicaid program, state Auditor-elect Rob Sand has plans to continue to investigate the health-care system in the future.

Lily Smith

Iowa State Auditor-elect Rob Sand speaks to supporters during the statewide Democratic candidates’ watch party at Embassy Suites in Des Moines on Wednesday, Nov. 7.

Julia DiGiacomo, Politics Reporter
November 27, 2018

The investigation into Iowa’s privatized Medicaid system has recently developed into a focus of the state Auditor’s Office.

Auditor-elect Rob Sand was the only Democratic challenger to unseat a Republican incumbent for statewide office, and on Jan. 1, he will bring his background in public-corruption prosecution as former assistant attorney general with him to the Auditor’s Office.

Throughout Sand’s campaign, one of his main promises was to investigate the state money funneled into the two managed-care organizations that oversee patients on Medicaid. Though as auditor he doesn’t have the ability to prosecute wrongdoing if he finds any.

Sand said that as long as someone is spending taxpayer money, the Auditor’s Office is able to investigate how the money is being used in order to determine if it is being handled appropriately, legally, and responsibly.

“We’ll be taking a look by talking not just to managed-care organizations but to providers and also to patients as well, making sure we’re looking everywhere we can for as much truth as possible about what’s going on,” Sand said in a phone interview with The Daily Iowan after the election.

The role of state auditor is commonly described as the taxpayers’ watchdog.

More specifically, Iowa State University Professor (and head of the Accounting Department) William Dilla said the two main duties of the Auditor’s Office are to handle routine financial audits of governmental units and lead special investigations when suspicion of corruption or financial wrongdoing arises.

Special investigations are what Sand proposes for Iowa’s managed-care organization system. Those would involve examining extensive financial information in order to discover and provide a report on the illegal or irresponsible action.

Dilla said it is important to note that although the Auditor’s Office can produce evidence of wrongdoing, such as embezzlement, financial irresponsibility, or corruption in the form of reports, it does not have the power to take the case any further. The case is handed over to other agencies with the power to prosecute, such as the Attorney General’s Office.

“[State auditors] can do the first step in building a case,” Dilla said. “They themselves can’t actually take the case to court. This has to go through a state agency. If it’s at a city or county level, it will probably have to go through a local prosecutor.”

Current state auditor and Republican Mary Mosiman released the results of a monthlong investigation of Iowa’s savings from Medicaid Monday after a request from Sen. Pam Jochum, D-Dubuque.

Previously, the savings estimated by the Department of Human Services ranged from $234 million for the budget period in January 2017, $47 million in December 2017, and $141 in May 2018. The fluctuating numbers drew criticism from opponents of the Medicaid transition.

Iowa Medicaid, an insurance program that enrolls approximately 600,000 low-income, disabled, or elderly Iowans, transitioned from state management to contracting with for-profit insurance companies for patient coverage in 2016.

Mosiman’s report indicates that around $126 million was saved this financial year and that the methodology used to estimate savings in May 2018 was most effective.

“The May 2018 savings of $141 million reported by the department was an accurate estimate based on the information available at the time,” according to the report released by Mosiman.

Sand said in a prepared statement he didn’t think the report went far enough, saying the audit did not “examine the impact on quality or timeliness of service.”

“We have no idea what we are getting for our money so can’t say if we are in better shape or worse,” the statement read.

Editor’s note: This story has been updated to reflect that Rob Sand was the only Democratic challenger to win office on election night. A previous version stated Sand was the only Democrat elected to statewide office.