Additional Efforts Against Medicaid Fraud Needed

CMS has improved efforts against Medicaid fraud but must do more to address the issue, according to a Government Accountability Office report released on June 30, CQ HealthBeat reports. According to the report, CMS since 2002 has taken action to limit "certain abusive financing schemes" that some states have used to obtain improper Medicaid reimbursements and has hired additional staff to review state Medicaid funding practices.

However, CMS has not developed mechanisms to measure the effect of policy revisions on the risk for improper Medicaid reimbursements and has not included the Medicaid Statistical Information System in the review of state Medicaid funding practices, the report finds. CMS also has not developed a plan for Medicaid financial management, according to the report.

Senate Finance Committee Chair Chuck Grassley (R-Iowa), who requested the report, said, "We can't let these dollars be squandered and lost to fraud, waste and abuse. ... CMS needs to take the GAO's recommendations to heart and implement them to ensure the stability of Medicaid."

In response to the report, CMS Administrator Mark McClellan said, "CMS is committed to further improving all Medicaid financial management activities and will continue to examine these issues" (Estes, CQ HealthBeat, 7/7).