States pep up enforcement efforts to root out Medicaid fraud

Author: Jaun Paul

Author: Jaun Paul

These days, if you have a Medicare compliance plan intact, thats not good enough. Nowadays, states are increasing enforcement efforts to root out Medicaid fraud, and the feds have decided that they are more keen on the joint-federal program than they have been in previous years.

What combine to create new compliance pitfalls for providers are dipping state revenues, an explosion of state false claim acts, and CMSs increased interest in the Medicaid Integrity Program.

According to Robert Markette Jr., a partner with Gilliland & Markette LLP, who recently gave an audio conference called Medicaid Fraud Enforcement Is on the Rise, state revenues are down, which makes it tougher to finance Medicaid programs. They like to focus on audit and fraud recoveries, because its a good way to get the money back in system.

Moreover, even the Deficit Reduction Act of 2005 is a key driver in the increase in enforcement. Many states have taken advantage of it as it gave states incentives to pass their own false claims acts (FCA).

The Deficit Reduction Act also requires providers who earn over a certain income level to educate their employees about the false claims acts. Now you need to tell your employees that if they pursue claims under it, they will get to keep a portion of the recovery.

Lastly, we can make mention of Medicaid Integrity Program, which was also created by the Deficit Reduction Act, as a joint federal and state program to ward off Medicaid fraud. In fact, under this program, CMS is providing a lot of educational resources.

So now since more entities will be keeping an eye on you, they are more likely to detect mistakes as well as fraud. So be prepared.

About the Author:

Provides weekly digest newsware about healthcare compliance, and offers advanced Learning Opportunities about Medicaid fraud and false claims acts for healthcare executives and physician billers according to Medicare compliance plan.

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