States share Medicaid fraud funding woes

Members of a congressional panel this month listened to repeated tales of inadequate funding and antiquated technology preventing numerous state Medicaid agencies from effectively combating fraud cases that result in billions of dollars lost nationally each year. Some state Medicaid agencies are cr

Members of a congressional panel this month listened to repeated tales of inadequate funding and antiquated technology preventing numerous state Medicaid agencies from effectively combating fraud cases that result in billions of dollars lost nationally each year.

Some state Medicaid agencies are critically underfunded and rely on 20-year-old computers to detect and track fraud, forcing them to seek the help of the private sector in identifying and recovering money from fraudulent claims, Medicaid officials told members of the House Commerce Committee's Oversight and Investigations Subcommittee. Medicaid may have lost $17 billion to fraud and abuse during fiscal 1998, according to General Accounting Office reports.

Subcommittee chairman Fred Upton (R-Mich.), called for aid from the federal level, specifically from the Health Care Financing Administration and the Office of the Inspector General at the Department of Health and Human Services.

"As anyone who has recently purchased a personal computer can tell you, technology is changing so rapidly...a [computer] purchased five years ago is hopelessly antiquated," Upton said in his opening remarks. "How, then, can we expect Medicaid state agencies, some of which are still using 10- or 20-year-old computer systems to process and review Medicaid claims, to have any hope of uncovering these new, highly complex fraud schemes?"

Penny Thompson, program integrity director at HCFA, said in her testimony that the agency is modifying its National Fraud Investigation Database, which contains Medicare information, to include Medicaid cases. That should help the states' efforts in identifying and stopping corrupt providers nationwide.

The agency also recently established a national fraud and abuse electronic bulletin board, co-sponsored by the American Public Human Services Association, to enable states to share information on pertinent issues, she said.

However, Thompson was not convinced that technology alone could solve the problem. "Technology can play a great role, but it doesn't substitute for expertise, resources and commitment that are [essential] for fraud programs," she told FCW.

Last year, in an effort to fight Medicaid fraud and waste, HCFA hired Malcolm Sparrow, an expert on health care issues, to conduct a series of seminars nationwide at which state personnel could discuss their concerns.

Those seminars determined that many states have "inadequate technological infrastructures and a basic inability to interrogate databases efficiently to ferret out proper claims."

HCFA chief information officer Gary Christoph did not attend the subcommittee hearings but did offer his views on technology's role in the Medicaid fraud process. "As we get more sophisticated in analyzing information [and data], there are ways that technology can help us, [specifically] through data mining," he said.

"I'm very interested in exploring the new data mining techniques because it's a tool that can help, but it's very difficult...because you can't eliminate 100 percent of the risk. You need to put tools in place to try and help you because what you might find today, you won't find tomorrow," Christoph said, alluding to the highly sophisticated schemes and mobility of individuals attempting to commit Medicaid fraud.

Subcommittee vice chairman Richard Burr (R-N.C.) said he was impressed with HCFA's technological efforts and plans to fight fraud that are under way.

But he noted that the overall structure of the system—including policies in which the federal government matches only 50 percent of money spent to combat fraud by states; the brief, 60-day time period for states to return overpayments made to recipients with federal money; and the lenient suspension rules meted out to individuals convicted of Medicaid fraud—need examination and legislation. He said the time for fact-finding missions is over.

"You don't need to [research] it—you need to deal with it and find a solution," Burr said. "[Frankly], HCFA doesn't hear the state folks." He said he anticipates legislative language that would institute some changes. "But I hope HCFA adopts them on their own" before that, he said.

A HCFA World Wide Web site located at fightfraud.hcfa.gov/mfs contains a listing of state statutes that target Medicaid fraud. It includes links to states' legislation on program integrity as well as contact information for the programs.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.