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GAO Report Finds Medicaid Audit Program Costs More Than it Recovers

An investigation by the U.S. Government Accountability Office (“GAO”), the nonpartisan investigative arm of Congress, revealed that the Medicaid audit program created in 2006 has cost taxpayers more than $100 million to operate since 2008, but only found $20 million in overpayments during that period.

The Centers for Medicare and Medicaid Services (“CMS”) is the federal agency that administers the Medicare and Medicaid programs. Medicare is a federal insurance program for the elderly and disabled. Medicaid, a $300 billion dollar a year program, provides insurance for low income individuals and families. Medicaid is run by the states, but jointly funded by the federal government and the states.

Medicare and Medicaid fraud is estimated by the Justice Department to cost taxpayers around $60 billion every year. Prior to 2005, policing Medicaid fraud, waste and abuse was left to the states.

The Medicaid Integrity Program (“MIP”), created by the Deficit Reduction Act of 2005 (“DRA”), was established with the intent to identify improper payments to doctors, hospitals and other Medicaid providers. Under the MIP, five contractors were hired to review state Medicaid records to identify potential audit targets, and five contractors were hired to audit the activities and claims by Medicaid providers to identify overpayments and other payment irregularities.

According to the GAO, more than sixty percent of the audits conducted by the MIP since 2008 were deemed “unproductive.” In its report released last week, the GAO recommended that the MIP engage in more collaborative audits with the states, redirect its efforts to generate more productive outcomes, and enhance its reporting under the DRA.

Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services, said of the current MIP contractors, three will not have their contracts renewed and two others will be reassigned.

If you have any firsthand knowledge, information, or evidence related to any federal, state, county or city government fraud, you should speak with an experienced qui tam lawyer who can help you understand your legal rights and help you obtain the compensation you deserve.

If you have a claim, contact the Florida whistleblower attorneys at McCabe Rabin, P.A. for a free and confidential consultation by calling toll free at 877.915.4040 or e-mail kelly@mccaberabin.com.

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