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Medicaid anti-fraud efforts need improvement, OIG says

NEWS IN BRIEF — Posted June 25, 2012

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Federal programs to crack down on Medicaid fraud need reforms to identify overpayments better, investigators told a Senate Homeland Security and Governmental Affairs subcommittee.

In evaluating several national Medicaid integrity programs, the Dept. of Health and Human Services Office of Inspector General found a variety of challenges that limit their potential to identify overpayments and potential fraud successfully, Ann Maxwell, OIG’s regional inspector general for evaluation and inspections, said at a June 14 hearing. She testified before the Federal Financial Management, Government Information, Federal Services and International Security subcommittee.

Significant shortcomings exist in the data available “to conduct efficient, national Medicaid program integrity oversight through data analysis and data mining,” Maxwell said.

Citing separate research from the Government Accountability Office, Sen. Tom Carper (D, Del.), the subcommittee’s chair, noted that one program that relies on Medicaid integrity contractors “only identified about $19.9 million in overpayments since 2008, yet we spent $102 million to operate the program during the same period.”

“We lost about $80 million for the taxpayers, and that’s not good,” he said.

Carper mentioned a bill he was co-sponsoring with Sen. Tom Coburn, MD (R, Okla.), to fight fraud, waste and abuse in Medicare and Medicaid. The legislation “would increase anti-fraud coordination between the federal and state governments, increase criminal penalties for fraud, encourage seniors to report possible fraud and abuse in Medicare through the Senior Medicare Patrol, and deploy cutting-edge data analysis technologies,” Carper said.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/06/25/gvbf0625.htm.

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