CMS to Target Medicaid Fraud and Abuse

BALTIMORE–CMS has launched a new program aimed at detecting and
preventing Medicaid fraud and abuse, the agency announced
Tuesday.

The new Medicaid Integrity Program will “yield significant
Medicaid savings to help sustain the program,” CMS Administrator
Mark McClellan said.

“Together with our state partners, we are implementing
unprecedented steps to assure that Medicaid funds do not support
criminal activities within the system,” he continued. “With rising
health care costs, Medicaid funds are needed more than ever to care
for the 55 million vulnerable Americans who depend upon it for
their health care.”

The fraud program was created by the Deficit Reduction Act with
funds that will rise from $5 million in 2007 to $75 million by
fiscal year 2009 and each year thereafter. Congress specifically
required the use of contractors to review the actions of those who
request payment from Medicaid, conduct audits, identify
overpayments and educate providers on program integrity and quality
of care. Congress also mandated that the agency devote at least 100
full-time staff to the project, which will be implemented in
collaboration with state Medicaid officials.

The new Medicaid program will coordinate with the Medicare
Program Integrity group on projects such as Medi-Medi, a pilot
project that shares data to detect improper billing and utilization
patterns, and the Payment Error Rate Measurement Program, which
calculates payment error rates.

Total expenditures for Medicaid, which is funded jointly by
states and the federal government, are expected to top $300 billion
this year.