A task force designed to root out fraud, waste and abuse in Illinois says the state could save an additional $50 million each year by improving coordination between state agencies, expanding the use of data analytics and directing additional resources toward the home health industry.
The state task force, which was one of several homegrown task forces featured in a special report by FierceHealthPayer: Antifraud earlier this month, issued a six-month report last week outlining a roadmap for ongoing fraud prevention efforts within the state.
The group noted that the Office of Inspector General for the Department of Healthcare and Family Services saved, recouped or avoided more than $220 million within the Medicaid program during fiscal year 2016, but added that the state could save an additional $50 million through more nuanced fraud, waste and abuse prevention efforts.
"The value of reducing fraud, waste and abuse is immense, and in these economic times, would allow the state to utilize funds currently being misspent to provide better programs and services,” Executive Inspector General Maggie Hickey said in an announcement.
The task force advocated for improved collaboration among state agencies as well as private insurers that serve as Medicaid managed care organizations (MCOs). Given the lack of “clear practices or procedures for regular communication,” the task force has placed new emphasis on increasing communication and sharing best practices with MCOs, developing a standardized fraud reporting tool, reviewing provider screening efforts and tracking fraud referrals online.
The task force also noted that although several state agencies use data analytics to help root out fraud and abuse, more could be done to share data. The state plans to upgrade its claims processing system to assist with fraud investigations, and place a greater emphasis on comprehensive audits.
Finally, the task force is launching an initiative focused increasing the dialogue among agencies that administer in-home care programs, which are particularly vulnerable to fraud. Nationally, federal authorities have underscored the fraud and abuse vulnerabilities within the home health industry.
The Illinois task force is just one of several state-based initiatives that have emerged recently. Both West Virginia and Pennsylvania have previously announced formalized task forced targeting healthcare fraud. Meanwhile, federal authorities have pointed to increased collaboration as a key element of large-scale fraud takedowns.