State regulators pull back on Medicaid audits

New York state has chosen to relent on its audits of Medicaid providers, a decision that has raised questions about the role of providers played in softening the process, reported The New York Times.

The change was announced amidst a high-profile Medicaid fraud trial of the former state Senate Majority Leader, the New York Daily News reported.

It comes even though the state's Office of the Medicaid Inspector General enjoyed great success in recouping overpayments to providers, noted the Times. In the first four years of the program, New York recouped $1.5 billion in overpayments.

However, providers have been grumbling about picayune scrutiny and hardball tactics they considered unfair. State regulators have agreed to collaborate with providers to change agency's policies and how it conducts audits, according to the Times article.

"An audit need not be an adversarial enterprise," James Introne, New York's deputy secretary of health, told the newspaper. "To the extent that an audit turns into an adversarial affair, it may not be conducted properly. An audit is successful when people agree."

Introne added that the state expected to recoup $1.1 billion in overpayments in 2012, higher than its predecessor.

However, consumer advocates have criticized the move.

"An industry that's regulated doesn't love the regulator unless the regulator isn't doing much," Arthur A. Levin, director of the Center for Medical Consumers, told the Times. "Asking the regulator and the regulated party to sit down and come to some sort of consensus on how the regulation should be - to me, it makes no sense."

To learn more:
- read the New York Times article
- read the New York Daily News article