CMS: Medicaid fraud audits 'disappointing'

Conducting Medicaid fraud audits costs the government five times more than the amount it finds, according to today's Government Accountability Office report. Auditing fees since 2008 amounted to $102 million, whereas investigators identified less than $20 million in Medicaid overpayments, Bloomberg reported.

"The results were extremely disappointing, way below what the expectations had been," Peter Budetti, director of program integrity at the Centers for Medicare & Medicaid Services, told Bloomberg.

The "disappointing" results draw questions into the financial waste that the anti-Medicaid fraud program ironically is intended to fight.

Since fiscal year 2008, more than two-thirds of the 1,550 Medicaid audits did not identify overpayments. Only a small fraction (4 percent) of the audits resulted in identifying $7.4 million in potential overpayments; the remaining audits (27 percent) are ongoing audits, according the GAO report.

GAO attributed the poor performance to ineffective Medicaid Statistical Information System (MSIS) data--state claims data that miss key information like provider names that are necessary for targeting potential fraudsters.

Traditionally, states handled Medicaid, but the Deficit Reduction Act of 2005 requires federal oversight through the Medicaid Integrity Program to support states in upholding integrity of the program. CMS also established the Medicaid Integrity Group (MIG) to implement and oversee the National Medicaid Audit Program (NMAP).

The Medicaid Integrity Group said it is redesigning the National Medicaid Audit Program to conduct collaborative audits, it but hasn't offered details to Congress.

"[T]he lack of a published plan detailing how the MIG will monitor and evaluate NMAP raises concerns about the MIG's ability to effectively manage the program," GAO stated. "Given that NMAP has accounted for more than 40 percent of MIG expenditures, transparent communications and a strategy to monitor and continuously improve NMAP are essential components of any plan seeking to demonstrate the MIG's effective stewardship of the resources provided by Congress."

CMS said three unnamed companies will not have their contracts renewed, and two others will be reassigned, Budetti told Bloomberg.

For more information:
- check out the GAO summary and report (.pdf)
- read the Bloomberg article

Related Articles:
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OIG: Weak Medicaid claims data fails to recover overpayments
OIG: Medicare, Medicaid anti-fraud program is ineffective
5 states top Medicaid fraud lists, states recover $1.7B

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