New Medicaid fraud program coming together

Sunday, October 29, 2006

WASHINGTON - The Medicaid Integrity Program is slowly taking shape, according to an Oct. 26 conference call held to describe the broad responsibilities of the plan.

Under the Deficit Reduction Act of 2005, CMS will receive $50 million in both 2007 and 2008, increasing to $75 million 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 Robb Miller, acting director of the Medicaid Integrity Group.

Beginning in April 2007, CMS will be required to report to Congress on how the $50 million is to be used.

"That requirement helps us focus on the return on investment that we'll be making," said Miller. "All partners (need to be) accountable-- the providers, the states, ourselves."

The responsibilities of the program are twofold: reviewing the actions of those providing Medicaid services and providing 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, developing an audit program in which CMS conducts provider audits in the field--something it has not done in the past. States will still oversee the bulk of their Medicaid programs, said Miller. The audit program is expected to begin in late 2007.

The second contractor is the Helix Group, which will work with states around the country to develop a baseline of information on the states about how they identify program integrity issues, and what they consider to be problems.

"For the first time, we will have the ability to compare apples to apples," said Miller. "We'll be able to measure the effectiveness of these states."

Miller lists flexibility as one of MIP's key philosophies.

"I learned early on that criminals are much more nimble than the government," said Miller. "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."