Tuesday, June 9, 2015

GAO Report Indicates Actions Needed to Improve Medicaid Fraud Controls

Dianne De La Mare

The General Accounting Office (GAO) has released a report titled Additional Actions Needed to Improve Provider and Beneficiary Fraud Controls, which concludes that “thousands of Medicaid beneficiaries and hundreds of providers were involved in potential improper or fraudulent payments during FY 2011” in AZ, FL, MI and NJ. 

Specifically, the report states that: 

1) approximately 8,600 beneficiaries had payments made on their behalf concurrently by 2 or more of the selected states; 
2) the identities of about 200 deceased beneficiaries received about $9.6 million in Medicaid benefits subsequent to the beneficiary’s death; and 
3) about 50 providers were excluded from federal health care programs, including Medicaid, for a variety of reasons including abuse and neglect, fraud, theft, bribery or tax evasion. 

Since 2011, the Centers for Medicare and Medicaid Services (CMS) has taken regulatory steps to make the Medicaid enrollment process more rigorous and data driven; but according to the report, gaps in beneficiary-eligibility verification guidance and data sharing continue to exist. GAO recommends that CMS issue guidance for screening deceased beneficiaries and supply more complete data for screening Medicaid providers. 

To obtain a copy of the complete report go to http://www.gao.gov/products/GAO-15-313.

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