Amid concerns about rampant Medicaid fraud and abuse, the U.S. Senate Committee on Homeland Security and Governmental Affairs, Subcommittee on Federal Financial Management, Government Information, and International Security held a hearing on March 28 “to examine current infrastructure for Medicaid integrity” and review oversight for uncovering improper Medicaid spending. CMS and HHS officials testified that the new Medicaid Integrity Program, created with the recent passage of the Deficit Reduction Act of 2005, would allow federal agencies to better support and monitor states’ efforts to police fraud.
Dennis Smith, Director of the Center for Medicaid Services, testified that with the funds appropriated for the Medicaid Integrity Program--$5 million for FY 2006, $50 million for FY 2007 and 2008, and $75 million for each year after--CMS will add 100 FTEs devoted to anti-fraud and abuse operations. The agency currently has 8.1 FTEs dedicated to preventing Medicaid fraud. CMS is now also mandated to review and audit Medicaid providers and will increase its oversight of state anti-fraud initiatives and provide training on best anti-fraud practices to the states.
Daniel Levinson, Inspector General, HHS, said the OIG will continue to make the following three areas its highest investigative priorities: nursing home quality of care, pharmaceutical manufacturer fraud, and drug diversions. As a result of DRA funding, however, the OIG will devote greater resources and a “full time OIG presence” to such programs as the Medi-Medi program, which compares billings by the same providers to identify patterns of fraud, in order to increase the number and quality of cases referred to law enforcement.
