Medicaid Fraud and Abuse Enforcement

Government Report details OIG Focus

According to a recent government report and proposed federal legislation, expect an increase in Medicaid Fraud and Abuse enforcement in 2006.

Health care savings and recoveries from Medicaid fraud were at the highest in 2005 and the push is on for more.  The funds are reportedly from settlements, judgments, and administrative penalties. The Office of Inspector General (OIG) has been recovering substantial sums of money from both large and small health care providers based typically on allegations of Medicaid fraud and abuse. The report also details that funds are allocated to Centers for Medicare and Medicaid Services (CMS) specifically to combat fraud in Medicaid and the State Children’s Health Insurance Program (SCHIP).

In addition, a bill was proposed that would give states a direct financial incentive to enact state false claims statutes and to pursue state false claims cases. This bill also provides that the state false claims laws do not have to be limited to Medicaid fraud, so states may choose to apply the laws more broadly. In addition, the legislation would increase spending for Medicaid fraud and abuse control activities. This includes an additional $25 million each year beginning in 2006 through 2010 for Medicaid activities of  the OIG. The bill would also establish a Medicaid Integrity Program, much like the Medicare Integrity Program.