An ongoing “restructure” of the Medicaid Integrity Contractors Program will focus on cases identified as priorities by state Medicaid programs, he said, while the data analytics program will focus more on both the dual-eligible beneficiaries treated by both Medicare and Medicaid and the providers who treat them.
“In both cases, these are things that we are paying very close attention to and we want to improve,” Budetti said.
Budetti's comments followed criticism of the programs during Tuesday's hearing by Sen. Tom Coburn (R-Okla.), who criticized the Medi-Medi program for costing about $60 million while recovering only $57.8 million in 2007 and 2008, according to a recent federal audit (PDF). Similarly, the Medicaid contractors recouped less than what was spent on them. In March, the inspector general reported the contractors identified $6.9 million in overpayments for six months of the year in which the CMS paid them $30.5 million.
Daniel Levinson, inspector general for HHS, told the senators that he urged the reorganizing due to the programs' “negative rate of return.”
“When you have a negative return, then the structure is a problem,” he said.
Among the changes the programs also are undergoing, Budetti said, are new ways to quantify their contributions to fraud reduction, which he said are larger than characterized by the inspector general's office and Republican critics.
“Frankly, it's much more effective than it has been characterized,” he told Modern Healthcare.
Coburn also challenged the oft-repeated federal boasts that its anti-fraud efforts produce a 7-to-1 return in recoveries. The actual ratio is closer to 4-to-1, he said, because the federal government spent more than $1 billion on total healthcare anti-fraud efforts and recovered about $4.1 billion in fiscal 2011.
Levinson said the 7-to-1 ratio applies to the anti-healthcare fraud efforts of his office.