- The Washington Times - Monday, July 14, 2014

State Medicaid systems are not using safeguards meant to avoid fraudulent claims, according to a Monday report from the chief investigator at the Department of Health and Human Services.

States are federally mandated to participate in Medicaid Interstate Match, which collects information on Medicaid recipients into a national depository. The program then looks for social security number matches to deter recipients from claiming benefits in two states at the same time, according to HHS’s Office of the Inspector General.

“Fourteen States did not submit Medicaid enrollment data for all beneficiaries in their State; five States [among them] reported that barriers related to resources or technical capability limited their ability to submit Medicaid enrollment data,” the report said.

The inspector general declined to name the 14 states that did not submit information for the program.

Some lawmakers, such as Rep. Peter Roskam, have looked to fraud-prone Medicare and Medicaid for spending reductions in the past few years. The Illinois Republican, who is currently tackling Medicare fraud committed by providers, said beneficiary fraud under Medicaid was no less of an issue.

“You would think the billions we lose annually in improper payments would be enough to motivate [Centers for Medicare & Medicaid Services] to actively promote and even require the most basic information sharing between states and the federal government, but clearly there is little regard for saving taxpayer dollars,” he wrote in an email to The Washington Times.

Mr. Roskam added that similar issues were present in “Medi-Medi,” a data-sharing program between Medicare and Medicaid that has only has 19 states as active participants.

The inspector general’s report also detailed some issues with the Centers for Medicare & Medicaid Services’ (CMS) management of Interstate Match and suggested four steps of participation — providing data, checking over half the matches, discontinuing benefits to fraudulent recipients and recovering any improper payments.

But according to the inspector general, states might not have the staffing or resources to submit data. Additionally, many states now use contractors as Medicaid providers under Medicaid managed care. These contractors know who receives benefits, making the information hard to obtain for states.

This led to a domino effect; because of the lack of data filed, only 30 percent of matches were ever checked for fraud.

Managed care was also a problem when states attempted to recover improper payments.

“States reported that in these cases, they did not recover any improper payments from the managed care organizations because of barriers such as lack of resources and length of time needed to recover improper payments,” the report read. “This suggests that if the States had not discontinued these beneficiaries’ benefits, they potentially would have made additional unrecoverable improper payments.”

No states were successful in recovering improper payments.

CMS guidance for participants in Interstate Match was additionally so broad that it did not include information like the fact that for the matching program to work, states had to submit all, and not just a portion, of beneficiaries’ data.

Mr. Roskam said this was an easy fix that might reduce the billions in Medicare and Medicaid fraud each year.

“This is low-hanging fruit when it comes to combating fraud and I am committed to ensuring oversight of CMS and demanding they take action,” he wrote.

Often, states didn’t even know how to use the waste-busting tool. The inspector general’s final recommendation is for CMS to give states more guidance in how to use Interstate Match, which CMS agreed to in a letter.

When asked for comment Monday, CMS deferred to its response in the report, which said, “[W]e appreciate the opportunity to comment on this draft report and look forward to working with OIG on this and other issues.”

Medicaid, which funds healthcare for Americans with incomes near or below the federal poverty level, is one of the most targeted government institutions for fraud. The Government Accountability Office estimates that $14.4 billion in Medicaid payments, or nearly 6 percent of the amount spent last year, were improper.

• Chloe Johnson can be reached at cjohnson@washingtontimes.com.

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