Government Audit Insider: Medicaid fraud referral process lacks standards
Healthcare Auditing Weekly, February 26, 2007
CMS lacks adequate criteria to measure state Medicaid agency performance in controlling Medicaid fraud, according to a recent OIG report.
The OIG reviewed suspected fraud referrals received by Medicaid Fraud Control Units (MFCUs) over a three-year period and concluded that only 29% of referrals came from state agencies.
Between 2002 and 2005, state MFCUs reported receiving a total of 13,733 suspected fraud referrals. Less than 4,000 of those referrals came from state Medicaid agencies. More than 80% of the MFCUs reported receiving less than half of their referrals from state agencies and 26 MFCUs reported accepting, on average, no more than one referral from their state agency.
The OIG recommended that CMS establish fraud referral performance standards for state Medicaid agencies. CMS concurred with the OIG's recommendations and stated that it plans to conduct a state program integrity assessment project.
Click here to read the complete OIG report.
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