OIG: Medicare, Medicaid Fraud Program Is Ineffective

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OIG: Medicare, Medicaid Anti-Fraud Program Is Ineffective

April 20, 2012 — 11:58am ET | By Karen M. Cheung

The anti-fraud Medicare-Medicaid Data Match program, known as the Medi-Medi program, "produced limited results and few fraud referrals," the Office of Inspector General said in a report released this week.

The 10 states that volunteered to participate in the program received $60 million in appropriations but avoided and recouped only $57.8 million during 2007 and 2008, the OIG found in its review of data from the Centers for Medicare & Medicaid Services, program safeguard contractors, state Medicaid program integrity agencies and other federal and state agencies.

The Medi-Medi program analyzes billing trends across the federal and state programs to identify potential fraud, waste and abuse, or at least, that's the goal. The OIG found the program produced 66 referrals to law enforcement--27 of which they accepted. On average, each state in the Medi-Medi program averaged 2.8 Medicare referrals to law enforcement per year, and law enforcement accepted an average of 1.15 referrals per state annually, according to the OIG report summary.

The weak results have the OIG questioning whether the Medi-Medi program should be even included in CMS' overall program integrity strategy.

CMS suggested the report might have been a little hard on the program, noting the review period doesn't reflect improvements CMS has made, including establishing the Center for Program Integrity, which leads a collaborative effort for Medicare and Medicaid integrity groups to work together.

"Since the period of review of this report (2007-2008), CMS has made significant strides in enhancing the effectiveness of the Medi-Medi program and the agency's overall program integrity efforts," Acting Administrator Marilyn Tavenner wrote in a letter to the inspector general. "... The Medi-Medi program has been a useful tool in helping to fight fraud, waste and abuse. The program continues to refer potential fraud referrals to law enforcement, and CMS is examining opportunities to share best practices among states that have had successful referrals."

To learn more:
- read the OIG summary
- see the full report (.pdf)

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Thank You Fierce Healthcare and Ms Cheung