OIG: 14 States Failed To Submit Anti-Fraud Information to Database

July 16, 2014 in News

Several state Medicaid systems have failed to submit all of their Medicaid beneficiary data to a national database designed to prevent fraudulent claims, according to a report from the HHS Office of Inspector General, the Washington Times reports.

Background

States are required to participate in the Medicaid Interstate Match program, which collects and stores beneficiary information in a national database and then scans that data for duplicate Social Security numbers.

According to the Times, the duplicate numbers could indicate that benefits claims had been filed in more than one state.

Report Details

The report found that 14 states — which OIG did not identify — failed to submit all their Medicaid beneficiaries’ enrollment data. Of those states, five reported “barriers related to resources or technical capability” that limited their ability to submit the required data.

The report also found that the incomplete data meant that only 30% of matches in the program were checked for fraud. In addition, it found that no states in these cases were successful in recovering improper payments, noting that many states encountered difficulties when they tried to recover payments from managed care organizations because “of barriers such as lack of resources” and time constraints.

Recommendations

OIG recommended that CMS improve its management of the matching program by:

  • Providing data;
  • Checking at least half of the matches;
  • Discontinuing payments identified as improper; and
  • Recovering any improper payments.

It also called on the agency to give states more guidance on how to use the tool, which CMS agreed to do (Johnson, Washington Times, 7/14).

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