Are You Catching Medicaid Fraud?

Your office should be searching out fraud everyday in order to make sure you get paid.  

Using the Medicaid data base is a good place to start.

Surprisingly, many states choose not to participate in a federal fraud data base called the Medicaid Interstate Match.  The data base matches Medicaid recipients social security numbers with Medicaid recipients in other states.  By using the data base, the state will be alerted if the Medicaid recipient is receiving Medicaid benefits in more than one state.  19 States are searching for fraud; but the others are not.

“Fourteen States did not submit Medicaid enrollment data for all beneficiaries in their State; five States [among them] reported that barriers related to resources or technical capability limited their ability to submit Medicaid enrollment data.”

States might not have the staffing or resources to submit data. Additionally, many states now use contractors as Medicaid providers under Medicaid managed care. These contractors know who receives benefits, making the information hard to obtain for states.  This led to a domino effect; because of the lack of data filed, only 30 percent of matches were ever checked for fraud.  Article

As with all areas of healthcare, providers, states and the federal government must work together to find, detect and eliminate fraud.  The FBI estimates that healthcare fraud ranges from $75 billion to $250 billion per year.  

Working together is the only way to make a dent in healthcare fraud.

What can your office do?

1)  Check the ID of all patients and place a copy in the chart; 
2)  Check the insurance information for patients regularly;
3)  Report any suspicious activity promptly; and 
4)  Update your compliance program to confirm there is no fraud in your office.

Do you need help training your staff about detecting fraud?  We can help.  CLICK HERE.

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