Dylan Scott is a GOVERNING staff writer.E-mail: email@example.com
Eradicating Medicaid fraud has become a central focus for states in recent years, especially as the low-income insurance program has consumed more and more of state budgets. It’s good politics because the public doesn’t like government waste, and it’s good policy because the fiscal pressures mean states could use every extra dollar to fund the program. There are limits to what it can do -- federal estimates place the amount of Medicaid waste in 2012 at $19 billion for federal dollars, while the most recent figures for state spending was $11 billion in 2010. For context: the federal government and state spent more than $450 billion combined in 2012. But these days, every little bit helps.
But how can states actually stop it?
That’s an ongoing question. The Centers for Medicare and Medicaid Services (CMS), which oversees the program from the federal side, recently compiled a list of best practices (dubbed “noteworthy picks”) to disseminate good policies that states had implemented to eliminate fraud. They take on a variety of forms: not doing a business with frequently problematic providers; verifying that services that are being paid for have been performed; using data analysis to detect irregularities; and instituting a greater managed-care approach to ensure an accountable entity is overseeing all of a Medicaid patient’s care.
The Pew Center on the States compiled the CMS review of all state Medicaid fraud practices into a searchable database (available here and highly recommended). Governing searched the information for noteworthy picks only and picked out some of the most interesting examples:
There are more great examples in the Pew database, which also allows users to break down by type of activity and by state. As states prepare for the an influx of Medicaid enrollees when the Affordable Care Act’s expansion takes effect next year -- which will result in hundreds of billions more dollars going into the program --fraud enforcement will continue to be emphasized, both at CMS and in the states.
Written and compiled by staff writers and editors, GOVERNING View is an on-the-ground, and sometimes behind-the-scenes, look at the topics we're covering in print and online. From notes on what's up in statehouses, county courthouses and city halls, to encounters with people, places and things, GOVERNING View is a window into the side of state and local government you don't always see.