Health-Care Fraud Fighting Gets Boost Amid Budget Cuts


Last week’s release of the Trump administration’s budget blueprint was bad news for many agencies, but health-care fraud fighting bucked the trend with an increase in funding. While there was an overall proposed $15 billion cut in funding for the Department of Health and Human Services, the budget blueprint proposed a $70 million boost for the Health Care Fraud and Abuse Control account, which coordinates federal, state and local law enforcement activities related to health-care fraud and abuse.

The proposed increase represents a commitment to fighting fraud, Ellyn Sternfield, a health-care attorney with Mintz Levin in Washington, told me recently, but questions remain regarding Medicaid anti-fraud tools. Sternfield said Medicaid Fraud Control Units have been crucial to past anti-fraud success, but potential health-care reform could leave the program on the chopping block.

The American Health Care Act would repeal and replace parts of the Affordable Care Act, including phasing out the current Medicaid expansion and replacing it with block grants, Sternfield said. As a result, there could be fewer federal mandates and reduced federal funding, potentially impacting the MFCU program.

Sternfield said there’s been no talk of cutting the MFCU program, but “the devil will be in the details.” For example, would states still be required to have an MFCU under a block grant program, Sternfield said, or would the Office of Inspector General still maintain an MFCU grant program.

States are required to create an MFCU that's separate from the state Medicaid agency and intended to investigate and prosecute Medicaid provider fraud as well as any fraud in the administration of the Medicaid program. The federal government provides 75 percent of the program's funding through a grant program overseen by the Health and Human Services OIG.

Read my full story here.

Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.

Learn more about Bloomberg Law and sign up for a free trial.