U.S. announces new Medicaid audit program aimed at preventing fraud

Don Berwick

Special auditors will be hired by individual states to identify over and underpayments, CMS officials said in a statement. Medicaid is the number one payer of nursing home services in the United States. The proposed contents of the regulation can seen at the Federal Register's website.

“Reducing improper payments is a key goal of the administration, and the tools provided by the Affordable Care Act will help us achieve that goal,” said CMS Administrator Donald Berwick, M.D. “We are using many of the lessons that we learned from the Medicare RAC program in the development and implementation of the Medicaid RACs, including a far-reaching education effort for health care providers and State managers.”

States must establish Medicaid RAC programs by submitting state plan amendments to CMS by Dec. 31, 2010, officials said. Their proposal outlines requirements that states must meet, as well as the federal contribution CMS will provide to assist in funding the new RAC programs. CMS officials have requested comments from interested stakeholders and are offering educational programs to help states “understand both the Medicare and Medicaid RAC programs.” CMS previously released a State Medicaid Director letter on Oct. 1 that provided initial guidance to the States regarding the newly proposed program.