Medicaid:

Federal and State Leadership Needed to Control Fraud And Abuse

T-HEHS-00-30: Published: Nov 9, 1999. Publicly Released: Nov 9, 1999.

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William J. Scanlon
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Pursuant to a congressional request, GAO discussed ways to combat fraud and abuse in the Medicaid program, focusing on: (1) an overview of the problem; (2) key components of fraud control; and (3) the importance of federal and state cooperation.

GAO noted that: (1) GAO's body of work on health care fraud and abuse indicates that programs the size and structure of Medicaid are inherently vulnerable to exploitation; (2) fraud schemes often cross state lines and enforcement jurisdictions, entailing a number of federal, state, and local agencies that may have different or competing priorities in their efforts to investigate, prosecute, and enforce compliance; (3) experience shows that coordinating the efforts of the multiple players, investing in preventive strategies, and dedicating adequate resources to fraud control units are essential components of an effective program integrity strategy; and (4) GAO's work shows that the Health Care Financing Administration, the agency in the Department of Health and Human Services responsible for administering Medicaid federally, is in a position to work in partnership with the states to ensure an appropriate level of commitment in states' efforts to control Medicaid fraud and abuse.

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