Robin Mathias Quoted in Modern Healthcare
First of many? Vaccine probe may extend beyond Connecticut
Byline: Mark Taylor
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Last week’s settlement by a Connecticut hospital could be just the first as state Medicaid fraud-control units explore allegations that hospitals, physicians and other providers may be billing Medicaid and private insurers for children’s vaccines they received free, according to government sources and healthcare fraud experts.
Healthcare billing fraud consultant Robin Mathias, former director of data analysis and budget for Indiana’s Medicaid program, said the vaccine billing scheme has likely spread beyond Connecticut’s borders.
“Regardless of what the federal agencies are saying, I suspect that other Medicaid programs will be looking into whether they’ve been billed for the VFC free immunizations,” said Mathias, who advises health plans about fraud schemes. “Whether or not it was fraud or an honest error, those providers would have been essentially paid twice for the same service, and that’s illegal.”
She said hospitals, many of which operate outpatient, immunization and community clinics, could face liability.