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Reducing fraud and abuse.

One of the most discussed items in the health care reform debate has been reducing fraud and abuse in the Medicaid Program. The Senate Special Aging Committee conducted a hearing on Medicare and Medicaid fraud on May 6. While senators heard testimony from the New York Office of the Medicaid Inspector General, they did not hear testimony from any Medicaid programs and therefore, did not hear directly about the strong and aggressive work on fraud and abuse being conducted by state agencies throughout the country. The most important component of our work is that rooting out fraud and abuse is a team effort and should be conducted in that manner.

State Medicaid Directors, and our Program Integrity Directors, are becoming overwhelmed with overlapping and duplicative efforts to "ensure against fraud and abuse." These efforts are coordinated in such a way as to enhance program integrity efforts, not just duplicate the efforts of state staff. In many cases, multiple requests for data and information take time away from their core function of program integrity. In addition, the congressionally mandated rule that all identified overpayments be returned to the federal government within 60 days inhibits states' efforts to aggressively go after program abusers. For example, Alabama has sued 72 drug manufacturers and won jury verdicts in five trials. The court granted awards of more than $200 million. The Centers for Medicare and Medicaid Services, under the current statute, has asked for the federal share (over $149 million) even though the verdicts are being appealed to the state's Supreme Court. Unless this rule is changed, states have an extreme disincentive to pursue these types of judgments.

The state Medicaid directors stand ready to work with the administration and Congress to improve our efforts to insure the program's integrity and to guarantee that the tax dollars entrusted to us are used to finance health care services for the most vulnerable of our population.

Separately, the time has finally come to make the formal announcement of the inaugural class of the Robert Wood Johnson Foundation's Medicaid Leadership Institute. These six state leaders were competitively chosen from a strong applicant pool:

Toby Douglas, Calif.; Carolyn Ingram, N.M.; MaryAnne Lindeblad, Wash.; Lynn Mitchell, Okla.; Carol Steckel, Ala.; Sandeep Wadhwa, Colo.


National Association of state Medicaid Directors an affiliate of the American Public Human Services Association

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Title Annotation:affiliates' corner
Publication:Policy & Practice
Geographic Code:1USA
Date:Aug 1, 2009
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