Privatizing Medicaid complicates fraud detection

Outsourcing Medicaid management can throw a monkey wrench into anti-fraud efforts since many managed care companies don't provide all information states need to investigate fraud, the Kansas Health Institute reported. Kansas Medicaid fraud unit recoveries fell from $33.7 million in fiscal year 2013 to $28.7 million in fiscal 2014 after the state privatized its Medicaid program, the article noted. There were fewer case referrals, and the fraud control unit had to deal with inaccessible data and procedural bureaucracy. Though challenges vary by state based on contracts with managed care companies, this problem isn't unique to Kansas. "As more states turn to private-sector managed care organizations to try to stem Medicaid costs," the article noted, "one of the byproducts is that investigations increasingly face extra barriers to the information they use to fight fraud." Article

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