Administration to target Medicaid fraud next

On par with the Centers for Medicare & Medicaid Services' (CMS) release of the Medicaid final rule yesterday, Vice President Joe Biden and Health & Human Services (HHS) Secretary Kathleen Sebelius announced anti-waste measures, specifically targeting Medicaid, at a Cabinet meeting yesterday. The Administration's Campaign to Cut Waste aims to save an estimated $2.1 billion during the next five years, according to a CMS press release.

Based on the successful Medicare waste-reduction model, according to the press release, the Medicaid Recovery Audit Contractor (RAC) Program aims to fight waste and fraud in the state programs. The Medicare RAC program already has recovered about $670 million in 2011, up 800 percent from the previous year. And last week, the Medicare Fraud Strike Force arrested and charged 91 people in eight cities as the largest takedown in the Force's history, estimated at $295 million in billing schemes.

The government's close look at Medicaid may come as little surprise to the healthcare industry. Overall healthcare fraud prosecutions are on track to rise 85 percent, with the government having prosecuted 903 cases. That amounted to $4 billion recovered from health fraud cases in 2010.

"Today we are building on an already successful program that targets improper payments in our health care programs and recovers those dollars, making Medicare and Medicaid more reliable and responsible," said Sebelius. "We simply can't afford to see even one penny of our health care dollars wasted and expanding this program will help us reach that goal."

For more information:
- read the press release
- read the Revenue Cycle Institute blog post

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