Medicaid fraud prevention yields strong ROI

For every $1 spent on fraud prevention, Florida saves nearly $7
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Efforts to prevent Medicaid fraud and abuse have shown a big return on investment in Florida, where the state gained $6.80 for every dollar spent on prevention and recovery, according to a report released yesterday from the state Agency for Health Care Administration (AHCA).

The state's fraud unit employs 210 full-time workers and spent $16.7 million last year on investigations, Naples News noted.

But the state recouped almost $49.7 million in total collections. Of that, $44.2 million stemmed from overpayments, $200,000 in investigation costs, $5 million in fines/sanctions and $300,000 in interest, according to the report.

The AHCA attributed much of the Medicaid fraud prevention success to increased collaboration with the state Attorney General's office, as well as external partners.

"This report shows both agencies' commitment to work together and safeguard this program from major fraud and abuse," AHCA Secretary Liz Dudek said yesterday in a statement. "The agency continues to be forward thinking and is working toward increased use of technology and stakeholder collaboration to aid in fraud-fighting efforts."

However, not all anti-fraud efforts have boasted such a high ROI. For example, conducting Medicaid fraud audits costs the government five times more than the amount it finds. While auditing fees totaled $102 million since 2008, investigators identified less than $20 million in Medicaid overpayments, according to a June report from the Government Accountability Office, FierceHealthcare previously reported.

With such potential waste, Florida's AHCA and Attorney General's Medicaid Fraud Control Unit have called for advanced data-detection technologies and enhanced support for data-mining initiatives, among other recommendations, to better fight Medicaid fraud and abuse, according to the report.

For more:
- here's the statement and report (.pdf)
- read the Naples News article

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