Fraud: Overpayments prevented, billing privileges pulled

Sunday, January 4, 2009

TALLAHASSEE, Fla. - Two state agencies have prevented more than $100 million in Medicaid overpayments during the past three years, according to an annual fraud report released last week.

The Attorney General's Medicaid Fraud Control Unit (MCFU) and the Agency for Health Care Administration have also helped to recover more than $56.7 million in court judgments, fines and civil penalties during fiscal year 2007-08.

"Medicaid fraud diverts valuable healthcare resources away from those who truly need the assistance, and we will not permit that to go unnoticed and unaddressed," stated Attorney General Bill McCollum in a release. "Our resources are best utilized when we cooperatively combat this issue and I look forward to continued progress made on this front."

The MCFU and AHCA continue to work together on joint investigations, Medicaid program issues, and improving the referral process for allegations of fraud and abuse.

A copy of the report is available at:$file/2007-08MFCUReport.pdf.

Providers lose billing privileges

WASHINGTON - Under a CMS initiative to fight fraud, more than 1,000 providers in the Los Angeles and Miami areas have lost their Medicare billing privileges, according to news reports last week. CMS began a pilot project in 2007 focused on those two geographic areas, home to 5,600 HME providers. The 1,139 providers that lost their billing privileges failed to reapply to CMS, a requirement of the pilot project.