OIG Recommends CMS Provide Better Data to Identify Medicaid Fraud

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The Office of Inspector General has recommended CMS improve the quality of data it provides to contractors who review Medicaid claims for potential overpayments.  

Review Medicaid Integrity Contractors conduct data analysis assignments to recommend audit leads and identify potential fraud. The OIG conducted the study to see if there are any barriers in the program. It found Review MICs completed 81 percent of their assignments, but they had little involvement in specific audit leads and identifying potential fraud.

The OIG concluded that the Review MICs were "hindered in their ability" to accurately complete analysis because of missing or inaccurate data.  

CMS has concurred with the OIG's recommendations, which also include requiring Review MICs to recommend specific audit leads. CMS said it has several initiatives underway to improve the quality of data available for Review MICs and will also direct the Review MICs to include specific recommendations for potential audit targets.   

Related Articles on Healthcare Fraud:

Government Recovers $4.1B From Healthcare Fraud in 2011
In Fight Against Fraud, Government's Reliance on Whistleblower Suits Grows
HHS Urges Payors to Withhold Payments for Suspicious Claims


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