A newly unveiled database created by the Pew Charitable Trusts provides comprehensive information about states’ strategies for combating Medicaid fraud and abuse.
The Pew database, described by the organization as the first of its kind, centralizes information about anti-fraud initiatives gleaned from 70 reports published by the Centers for Medicare & Medicaid Services. Information is available for each state, and is broken into four categories: screening of potential and existing Medicaid beneficiaries; prepayment claim reviews; “pay and chase” programs that seek to recover funds improperly paid out; and practices that involve more than one of these categories.
For example, a user could refer to the database for information on Florida, where two nursing home executives were recently arrested for allegedly defrauding Medicaid to the tune of $2.75 million. The database indicates the Sunshine State has no prepayment review practices in place, but has two provider regulation practices, four post-payment recovery practices and four cross-category practices, based on CMS information dating from 2008.
The database also shows that CMS has identified three of Florida’s practices as noteworthy. CMS singled out Florida’s enrollment of billing agents as Medicaid providers, the high level of communication among state agencies overseeing and administrating Medicaid, and the practice of unannounced, pre-enrollment site visits to providers considered risks for fraud and abuse. These include Durable Medical Equipment and transportation vendors.