Massachusetts' Medicaid program doesn't have the resources or internal controls to detect fraud and abuse, and in fact, its audit program is so limited, only 51 of 215 million claims from 2001 to 2003 were set aside for fraud review, the state auditor said in a report. Based on federal and industry estimates, Massachusetts lost between $450 million and $1.57 billion to Medicaid fraud and abuse from 2001 to 2003 -- but recovered only $17.2 million, according to the report. The program paid out $15.7 billion for medical claims during that period. The auditor called on the state Health and Human Services Department to establish an internal audit unit and give the unit the resources to perform regularly scheduled and unannounced audits. In response, the department said it is setting up a new management system to better track fraud. The system should be unveiled in August 2007, the department said. Read the report. -- by Joseph Mantone
Mass. Medicaid program wide open to fraud: report
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