Medicaid directors propose reforms for fraud-detection programs

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State Medicaid directors outlined several different strategies for streamlining collaboration between Medicare and Medicaid antifraud efforts in a June 29 letter to members of the Senate Finance Committee.

In recent weeks the Centers for Medicare & Medicaid Services has received a flood of criticism for the high costs of antifraud audits, which have failed to collect anticipated overpayment revenue.

Nursing homes have said they are increasingly are being targeted by federal Medicare auditors and state Medicaid contractors seeking to recoup overpayments.

The letter, written by the National Association of Medicaid Directors, argues that “federal programs are typically not tailored to meet unique, state-identified fraud, waste, and abuse priorities and related program integrity activities, nor are they responsive to other inherent state variations such as state policies, program characteristics, and organizational structures.”

The Medicaid directors instead encouraged lawmakers to create a compendium of Medicaid best practice policies accessible to all states; give states real-time access to the automated provider screening system operated by CMS; establish a national program integrity adviser who could propose solutions to minimize duplication in Medicare and Medicaid program integrity requirements.

Click here to read the Medicaid directors' letter.


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