CHARLESTON, W.Va. - Governor Patrick Morrisey today announced that West Virginia is taking additional steps to protect taxpayer dollars and ensure Medicaid resources are directed to those who truly need them, following a formal response to Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services (CMS).
“West Virginia is building on a strong foundation to ensure Medicaid dollars are protected for our most vulnerable citizens,” said Governor Morrisey. “We fully support the federal government’s efforts to crack down on fraud, waste, and abuse, and we are taking decisive action to strengthen accountability across our system.”
The Governor confirmed with CMS that West Virginia will move forward with a swift revalidation of Medicaid providers of service at high risk of waste, fraud, abuse, and corruption.
West Virginia Medicaid already employs continuous monitoring and screening for all enrolled providers, including regular checks against federal and state databases to ensure eligibility and compliance. High-risk providers are subject to additional safeguards, including fingerprint-based background checks and site visits.
Under the Governor’s directive, the state will now:
- Increase the frequency of revalidation for high-risk providers, moving to a two-year cycle beginning June 1, 2026
- Reclassify select provider types into the high-risk category based on program integrity trends and enforcement data
- Prioritize revalidation reviews for providers that have not undergone screening within the past 12 months
- Strengthen enrollment and oversight standards to enhance accountability across the system
These actions build upon existing safeguards and reflect a broader commitment to staying ahead of increasingly sophisticated fraud schemes.
Governor Morrisey emphasized that West Virginia will continue working in close coordination with federal partners to safeguard Medicaid and protect taxpayers.
“We will not allow bad actors to exploit taxpayers or undermine care for those who depend on these services,” Governor Morrisey said. “If you are trying to game the system, West Virginia is not the place to do it.”
The West Virginia Department of Human Services will provide CMS with a comprehensive two-year strategy outlining additional program integrity measures within the next 30 days.