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Federal Funding for State Medicaid Fraud Control Units Still Needed

HRD-81-2 Published: Oct 06, 1980. Publicly Released: Oct 06, 1980.
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Highlights

Medicaid fraud costs American taxpayers millions of dollars annually. To help reduce the losses, Congress enacted the Medicare-Medicaid Anti-Fraud and Abuse Amendments authorizing 90 percent Federal matching payments for fiscal years 1978-80 as an incentive for States to establish Medicaid fraud control units. It was expected that this financial relief would enable many State Governments to establish new units or expand existing ones and that, after the units had been in operation a few years, they would begin to recover from prosecutions amounts equal to or exceeding their operating costs. The Department of Health and Human Services (HHS) Office of the Inspector General is responsible for certifying, funding, and monitoring the fraud control units. GAO reviewed 7 of the 30 existing State certified fraud units.

Recommendations

Matter for Congressional Consideration

Matter Status Comments
Congress should provide for funding the establishment and operation of State Medicaid fraud control units beyond September 1980.
Closed
Please call 202/512-6100 for additional information.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of HHS should direct the HHS Inspector General to verify, on a sample basis, the accuracy of the statistics included in the State fraud units' quarterly reports on their fraud investigation activities.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services The Secretary of HHS should direct the HHS Inspector General to develop a fraud unit training manual incorporating the most effective techniques and methods of dealing with Medicaid provider fraud based on the experience gained by the fraud units.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services The Secretary of HHS should direct the HHS Inspector General to determine which fraud units do not have adequate procedures for following up on the amount of overpayments actually collected and require them to establish appropriate procedures.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services The Secretary of HHS should direct the HHS Inspector General to decertify those State fraud units that do not meet the statewide prosecution requirement of the law and regulations.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services The Secretary of HHS should direct the HHS Inspector General to develop criteria, in consultation with fraud units and State Medicaid agencies, to guide Medicaid agencies on the extent to which a potential fraud case should be developed before referral to the fraud unit and what types of data and analysis should be included in the referral.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services The Secretary of HHS should direct the HHS Inspector General to issue guidelines on essential elements that should be included in a fraud unit's formal procedures with local prosecutors or working relationships with the State attorney general to assure statewide prosecution of fraud cases.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services The Secretary of HHS should direct the HHS Inspector General to reassess the the adequacy of the arrangements now in effect in States where the attorney general's office does not have statewide criminal fraud prosecution authority, or if it does, the unit is located outside that office to assure that prosecution can be carried out as needed statewide.
Closed
Please call 202/512-6100 for additional information.

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Educationstate relationsFraudHealth care costsHealth care servicesLaw enforcementMedicaidOverpaymentsProgram evaluationMedicare