Medicaid Faces Questionable Billing, High Rates of Improper Payments

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By James Swann  

The Medicaid program continues to face numerous fraud and abuse risks, including questionable billing patterns, overpayments, and a high rate of improper payments, according to a report from the Department of Health and Human Services Office of Inspector General released April 12.

The report, Medicaid Integrity Program Report for Fiscal Year 2012, provided highlights of Medicaid-related investigations and reviews OIG conducted in FY 2012, which were also included in OIG's Semiannual Report to Congress for FY 2012 (228 HCDR, 11/28/12).

Performance Problems for MICs

For example, three OIG investigations discovered Medicaid Integrity Contractors (MICs) were not effectively performing their duties to identify fraud, waste, and abuse.

In one case, OIG said a flawed Medicaid claims database made it nearly impossible for the MICs to identify fraud, waste, and abuse, and another investigation said a lack of collaboration between the MICs was leading to duplicate efforts (36 HCDR, 2/24/12).

OIG also discovered high risks of fraud and abuse in Medicaid managed care, despite the presence of safeguards designed to protect the program, the report said.

In addition to the investigative highlights, the OIG report included a list of Medicaid-related reports OIG released during FY 2012, as well as Medicaid-related recommendations that were included in OIG's December 2012 Compendium of Unimplemented Recommendations (234 HCDR, 12/6/12).

The report did not contain any new recommendations.

 


The OIG report is at https://oig.hhs.gov/reports-and-publications/medicaid-integrity/2012/medicaid_integrity_reportFY12.pdf.