OIG Rule: States Can Use Federal Funds for Medicaid Data Mining
On Friday, HHS' Office of the Inspector General published a final rule that allows state Medicaid fraud control units to use federal funding to pay for data mining tools that can help find fraudulent billing patterns, Modern Healthcare reports.
The units traditionally have been prohibited from using federal funding for data mining initiatives.
Final Rule Details
The rule allows fraud units to obtain a waiver to purchase data mining tools with federal funding if they submit a proposal describing how they will:
- Coordinate data mining efforts with state Medicaid agencies;
- Ensure that data miners are using the most up-to-date interpretations of state-specific Medicaid regulations; and
- Train unit staff on advanced computer-analysis, which is required for data mining (Carlson, Modern Healthcare, 5/17).
Under the final rule, OIG must approve each agreement between fraud units and state Medicaid agencies (Adams, CQ HealthBeat, 5/16).
The final rule is scheduled to take effect June 17.
OIG officials say that the rule will cost $12 million to implement.
However, OIG estimates that the rule will help recover $72 million from 2014 to 2023, or $6.90 in savings for each dollar spent (Modern Healthcare, 5/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.