HHS says few states have taken it up on an offer to receive federal funding for data-mining, which would allow their Medicaid fraud units to search claims. States say they don't need it, even though the improper payment rate has nearly doubled as the number of enrollees surges.
A 2013 HHS rule allowed state Medicaid fraud control units to use federal funds for the audits, which the agencies previously had been explicitly prohibited from doing.
Only California, Indiana, Louisiana, Michigan, Missouri and Oklahoma have been granted permission to conduct the data-mining. Florida's Medicaid fraud control unit received approval from the CMS to conduct data-mining as part of a Section 1115 waiver in 2010.
Earlier this year, the CMS revealed that the Medicaid improper payment rate has jumped from 5.8%, or $14.4 billion, in fiscal 2013 to 9.78%, or $29.12 billion, in fiscal 2015.
Richard Stern, director of the Medicaid Fraud Policy and Oversight Division in HHS' Office of the Inspector General, said he wishes that other Medicaid fraud control units would get on board as increased use of data-mining could be an effective tool to reduce improper payments, especially those relating to fraud.
Still, many of the states reached by Modern Healthcare said they believe their state Medicaid agencies or health departments are producing enough leads from their own data-mining efforts for them to pursue.
“We've yet to encounter a situation beyond (our Medicaid agency's) capacity to provide timely information that would necessitate the extensive investment in personnel, infrastructure, and equipment to essentially duplicate those resources,” said Josh DeVine a spokesman for Tennessee Bureau of Investigation.
Spokespeople for fraud units in Arkansas, Colorado, Massachusetts, Ohio, South Dakota, Texas and West Virginia made similar remarks.
State Medicaid fraud units in Hawaii, New Jersey and Rhode Island are evaluating how data-mining could benefit them, while a spokesman for New York said it may soon seek a waiver with HHS' OIG.
Some said they want to see how other states fare before enlisting the HHS' help.
“We are hoping that larger states can make progress in developing a road map for effective implementation before we commit to a specific data-mining strategy or technology,” said Carl Kanefsky, a spokesman for Delaware's Justice Department.