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New CMS Programs Attempt to Tackle Medicaid Fraud and Abuse

July 25th, 2018

The Centers for Medicaid and Medicare Services (CMS) has announced initiatives aimed at enhancing detection of Medicaid fraud and abuse.

From 2013 to 2016, the federal share of Medicaid payments grew from $263 billion to $363 billion. CMS Administrator Seema Verma said in a statement that the latest initiatives “are the vital steps necessary to respond to Medicaid’s evolving landscape and fulfill our responsibility to beneficiaries and taxpayers.”

One of the new initiatives involves audits of state claims for federal match funds and medical loss ratios. “Overall, audits will address issues identified by the Government Accountability Office and Office of Inspector General, as well as other behavior previously found harmful to the Medicaid program,” CMS said.

Other audits will involve closely analyzing how states make eligibility determinations. CMS said that the audits “will include addressing the effect of Medicaid expansion and its enhanced federal match rate on state eligibility policy.”

The other major initiative is meant to “optimize state-provided claims and provider data.” According to CMS, “The Trump Administration has made partnering with states a priority. CMS is committed to work closely with states to ensure that the agency and oversight bodies have access to the best, most complete and accurate Medicaid data.”