Medicaid integrity review contractors lacked adequate data to identify potential overpayment and fraud, according to an analysis of the program's early performance (PDF).
Lack of adequate data noted in MIC reviews
HHS' inspector general's office recommended greater access to state Medicaid data or an upgrade to federal data used by contractors to assess payments. The CMS endorsed the recommendation, said the report, which examined review contractors' performance during the first six months of 2010.
Review contractors identified $282 million in potential overpayments during the period from 113,378 unique providers, but did not recommend potential audits or identify possible fraud. The CMS has since required contractors to identify potential fraud, but should expand that requirement to include audit leads, the report said. The CMS has also launched efforts to improve contractors' data.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.