News and Commentary

Medicaid fraud alleged - New York Daily News

News and Commentary | Fraud Cases | Medicaid Fraud Cases

Medicaid fraud alleged - New York Daily News -
Medicaid fraud alleged
New York Daily News, NY - 7 hours ago
Dept. to investigate the home and the clinic for possible Medicaid fraud. The Medicaid fraud units of both the Health Dept. and

Medicaid billing fraud settled - Wyoming Tribune

News and Commentary | Fraud Cases | Medicaid Fraud Cases

Medicaid billing fraud settled - Wyoming Tribune -
Medicaid billing fraud settled
Wyoming Tribune, WY
“Wyoming’s piece is part of a $25 million settlement to be split among the United States, 30 states and the District of Columbia.

The government charged Pediatrix improperly billed Medicaid for its services between January 1996 and December 1999.

Review of Medicaid Eligibility in New York State, (A-02-05-01028)

News and Commentary | Links to Press Releases

October 10, 2006

Complete Text of Report is available in PDF format (1.6 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

Our objective was to determine the extent to which the State agency made Medicaid payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements. The State agency (1) made some Medicaid payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements and (2) did not always adequately document eligibility determinations. Of the 200 payments in our statistical sample, 16 payments totaling $874 (Federal share) were unallowable because the beneficiaries were ineligible for Medicaid. In addition, for 58 sampled payments totaling $10,699 (Federal share), the case files did not contain all documentation supporting eligibility determinations as required. As a result, for the 6-month audit period from January 1 through June 30, 2005, we estimated that the State agency made 4,217,888 payments totaling $230,375,748 (Federal share) on behalf of ineligible beneficiaries. We also estimated that case file documentation did not adequately support eligibility determinations for an additional 15,289,843 payments totaling $2,820,569,979 (Federal share). We did not recommend recovery primarily because, under Federal laws and regulations, a disallowance of Federal payments for Medicaid eligibility errors can occur only if the errors are detected through a State’s Medicaid eligibility quality control program. We recommended that the State agency use the results of this review to help ensure compliance with Federal and State Medicaid eligibility requirements. Specifically, the State agency should (1) reemphasize to beneficiaries the need to provide accurate and timely information and (2) require its district office employees to verify eligibility information and maintain appropriate documentation in its case files.

To build a better fraud trap

News and Commentary | In the News

To build a better fraud trap
Minnesota companies Ingenix and Fair Isaac are each working on technology to help identify false claims that contribute to skyrocketing health-insurance costs.

BY JULIE FORSTER
Pioneer Press

Ferreting out intentional crime from a legitimate mistake or simply a difference in opinion between a doctor and insurer is not always black and white. *Robin Mathias*, a health care fraud consultant based in Santa Rosa, Calif., noted that while it is cutting edge, the technology is not as clear-cut when used to find health care fraud as it is in finding fraud in the credit card industry.

Sebelius Says New Law Will Crack Down on Medicaid Fraud - Kansas City infoZine

News and Commentary | Healthcare Fraud Control Articles

States are enacting new laws to help fight Medicaid fraud.

Sebelius Says New Law Will Crack Down on Medicaid Fraud - Kansas City infoZine -

Medicaid fraud costs taxpayers money, and to crack down on this crime, Governor Kathleen Sebelius today signed a bill that expands the scope of the current fraud law.

CMS announcement of Medicaid and SCHIP Payment Error Rate Measurement System

News and Commentary | Healthcare Fraud Control Articles

CMS Notice of intent to establish a new system of records for the purpose of identifying payment errors and combating fraud and abuse in State Medicaid and SCHIP programs. CMS will contract for required services.

CMS invites comments on all portions of this notice.

Full Text at CMS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

KANSAS ACTS ON MEDICAID FRAUD - Kansas City Star

News and Commentary

KANSAS ACTS ON MEDICAID FRAUD - Kansas City Star -
KANSAS ACTS ON MEDICAID FRAUD
Kansas City Star, MO - 8 hours ago
Allow the state to seize assets acquired through Medicaid fraud. The law also would make it a crime to obstruct a Medicaid fraud investigation.

Businessman guilty in wheelchair fraud case - abc13.com

News and Commentary | Fraud Cases | Medicaid Fraud Cases | Medical Equipment Fraud Cases | Medicare Fraud Cases

Businessman guilty in wheelchair fraud case - abc13.com -
Businessman guilty in wheelchair fraud case
abc13.com, TX - 8 hours ago
24th for a San Antonio businessman convicted in a Medicare and Medicaid billing scheme. He was convicted Friday on six counts of federal health care fraud.

Probe into Medicaid - Newsday

News and Commentary | Fraud Cases | Medicaid Fraud Cases
XML feed