MEDICAID ANTI-FRAUD PROGRAMS - THE ROLE OF STATE FRAUD CONTROL UNITS - HEARING BEFORE S SPECIAL COMMITTEE ON AGING, JULY 25, 1978

• NCJ Number: 68108
• Author(s): ANON
• Date Published: 1979
• Length: 55 pages
• Corporate Author: US Congress
• Sale Source: Superintendent of Documents, GPO; National Institute of Justice/
• Publication Type: Legislative/Regulatory Material
• Language: English
• Country: United States of America

Annotation

TESTIMONY FROM FOUR WITNESSES FOCUSED ON IMPLEMENTATION PROBLEMS OF FEDERAL LAWS WHICH PROVIDE FUNDING FOR STATES TO ESTABLISH SPECIAL UNITS TO INVESTIGATE MEDICAID FRAUD.

Abstract

MEDICARE/MEDICAID ANTI-FRAUD AND ANTI-ABUSE AMENDMENTS ENACTED IN 1977 AUTHORIZED 90 PERCENT FUNDING FOR STATE INVESTIGATIVE UNITS FOR A 3-YEAR PERIOD, BUT BY MID-1978 ONLY NINE STATES WERE PARTICIPATING IN THE PROGRAM. THE HEARINGS EXAMINED THIS SLOW RATE OF PROGRESS, THE FUTURE OF SUCH UNITS WHEN FEDERAL FUNDING EXPIRES IN OCTOBER 1980, AND IMPLEMENTATION OF THE AMENDMENT'S PROVISIONS CONCERNING OWNERSHIP AND MANAGEMENT DISCLOSURE FOR MEDICAID PROVIDERS. AN OFFICIAL FROM THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE'S (DHEW) HEALTH CARE FINANCING ADMINISTRATION STATED THAT 35 STATE UNITS SHOULD BE CERTIFIED BY THE END OF 1978. HE ALSO DISCUSSED REASONS WHY SOME STATES WILL NOT ESTABLISH INVESTIGATIVE UNITS, THE IMPORTANCE OF PAYMENT DATA SYSTEMS IN IDENTIFYING FRAUD, AND PROCEDURES TO IMPLEMENT THE DISCLOSURE REGULATIONS. A DEPUTY INSPECTOR FROM HEW'S OFFICE OF THE INSPECTOR GENERAL DESCRIBED ITS ROLE IN ASSISTING STATE FRAUD UNITS AND SUPPORTED THE CONCEPT OF THE STATE PROGRAMS. TOPICS COVERED IN THE SUBSEQUENT DISCUSSION AMONG THESE WITNESSES AND COMMITTEE MEMBERS INCLUDED FEDERAL EFFORTS TO COMBAT MEDICAID FRAUD, JURISDICTION PROBLEMS BETWEEN STATE AND FEDERAL GOVERNMENTS, THE OFFICE OF PROGRAM INTEGRITY, AND COST BENEFIT ANALYSIS OF THE ANTI-FRAUD PROGRAM. NEW YORK'S PROBLEMS WITH MEDICAID FRAUD WERE DETAILED BY A DEPUTY ATTORNEY GENERAL WHO ALSO CRITICIZED THE SLOW PACE OF CERTIFICATION. AN OFFICIAL INVOLVED WITH CONNECTICUT'S MEDICAID FRAUD INVESTIGATIVE PROGRAM RECOMMENDED THAT, ALTHOUGH MOST COLLECTIBLE CASES WERE IN THE AREA OF ABUSE, THE STATE FRAUD UNITS SHOULD BE CONTINUED FOR THEIR DETERRENT VALUE. PROBLEMS IN BALANCING SERVICE DELIVERY WITH FRAUD INVESTIGATIONS AND CONNECTICUT'S INFORMATION SYSTEM WERE EXAMINED. THE APPENDIXES CONTAIN CORRESPONDENCE RELATING TO THE HEARING FROM HEW OFFICIALS, WISCONSIN'S DEPARTMENT OF JUSTICE, AND THE DIRECTOR OF CONNECTICUT'S MEDICAL CARE ADMINISTRATION. (MJM)