CMS Developing Program To Control Medicaid Fraud
CMS is developing a program to help control Medicaid fraud at both federal and state levels that likely will be ready within the next six weeks, Dennis Smith, director of CMS' Center for Medicaid and State Operations, said at a Tuesday hearing of the Senate Homeland Security Subcommittee on Federal Financial Management, Government Information, and International Security, CQ HealthBeat reports. The program will provide oversight of Medicaid providers and also will boost oversight of state "program integrity" operations, including training and best practice guidance.
Smith said the budget reconciliation act passed in February provides millions of dollars in funding to help identify and prevent Medicaid fraud through additional staff and other resources. He added that the funding will help the program expand nationally.
Smith noted that nine states currently have programs in place in which federal and state officials work together to find fraudulent billing in both Medicaid and Medicare.
Sen. Tom Coburn (R-Okla.), chair of the subcommittee, said that health care providers are defrauding Medicaid because "no one thinks they're going to get caught." He said fraud is a "huge problem" and could cost the federal government as much as $39 billion by 2016.
Coburn said, "CMS has no accurate picture of fraud control efforts in ... a majority of states" because most of the fraud control is done by states themselves, and audits of the states occur about every seven or eight years.
In addition, committee member Sen. Daniel Akaka (D-Hawaii) requested assistance from Coburn in changing a provision in the budget reconciliation act mandating that individuals applying or reapplying for Medicaid must verify their citizenship through extra documentation.
Akaka said, "An estimated 3.2 to 4.6 million U.S.-born citizens may have their Medicaid coverage threatened simply because they do not have a passport or birth certificate readily available." Akaka added, "Many others will also have difficulty in securing these documents, such as Native Americans born in home settings, Hurricane Katrina survivors, and homeless individuals."
Coburn said he would like to hold a hearing on the matter within the next three to four months (Carey, CQ HealthBeat, 3/28).