Government not focusing on Medicaid fraud, says GAO: August 27.

The Centers for Medicare and Medicaid Services (CMS) is engaged in several initiatives designed to support states' Medicaid program integrity efforts, but the agency's oversight is limited, says a new report by the General Accounting Office (GAO).

The report, based on a survey completed by 47 states, found that various forms of fraud and abuse, which include billing for services, drugs, equipment, and supplies not provided or needed, have resulted in substantial financial losses to states and the federal government. In a recent case, 15 clinical laboratories in one state billed Medicaid $20 million for services that had not been ordered.

States reported using information technology, enrollment controls, and claims reviews to help strengthen their integrity activities. They also cited legislation that directs the use of certain preventive or detection controls or authorized enhanced enforcement powers as lending support to their program integrity efforts. However, says GAO, CMS' current on-site review process, which aims to review the integrity efforts of eight states a year, may be "disproportionately small relative to the risk of serious financial loss."