CMS has announced a “comprehensive and systematic approach” to combating Medicaid fraud with funds that will increase from $5 million in 2007 to $75 million by FY09 and each year thereafter. The new Medicaid Integrity Program was created by the Deficit Reduction Act of 2005 and specifically requires the use of contractors to review the actions of those seeking payment from Medicaid, conduct audits, identify overpayments, and educate providers and others on program integrity and quality of care. Congress also mandated that the agency devote at least 100 full-time staff to the project.
The MIP will employ several major strategies, including targeting vulnerabilities in the Medicaid program; providing training and technical assistance to states while also conducting oversight of their activities; supporting criminal investigations of suspect providers while concurrently seeking administrative sanctions; employing lessons learned in developing guidance and directives aimed at fraud prevention; and developing effective ROI strategies. “Together with our state partners, we are implementing unprecedented steps to assure that Medicaid funds do not support criminal activities within the system,” said CMS Administrator Mark McClellan.
