Medicaid fraud program takes shape

Thursday, November 30, 2006

WASHINGTON - The director of the Medicaid Integrity Program, which has been charged with Medicaid reform, said the program must operate in a flexible manner in order to fulfill its mission.
"I learned early on that criminals are much more nimble than the government," said Robb Miller, active director of the Medicaid Integrity Group in an Oct. 26 conference call. "We need to remain as flexible as possible to address emerging issues and be prepared to take on new threats as they develop to the Medicaid program."
The Deficit Reduction Act of 2006 provided CMS with $50 million in both fiscal years 2007 and 2008, and $75 million annually starting in 2009, to combat fraud and abuse. CMS will also hire 100 full-time employees to develop ways to combat fraud and abuse.
"CMS welcomes and embraces its role as the national leader in the Medicaid program and is very pleased to be able to develop the first national strategy to combat Medicaid fraud and abuse," said Miller.
Beginning April 2007, CMS must report to Congress on how it's using the $50 million.
The responsibilities of the program are twofold: review the actions of those providing Medicaid services and provide support and assistance to the state to combat Medicaid fraud, waste and abuse.
To do so, MIP has hired two contractors. Catapult Consultants will serve as audit program development contractor.
The second contractor, the Helix Group, will work with states to develop a baseline of information on how the states identify program integrity issues, and what they consider to be problems.