Medicaid Fraud In the News

By Mike Betron, Infoglide Director of Marketing

Medicaid is in the news almost daily, as states take steps to crack down on fraudulent claims. For example, Maryland is in the process of passing stiffer laws to support its efforts to reduce the 5-10% of fraudulent claims made that draw from the $6.2 billion it pays out annually. Other states like Texas, New Jersey, New York, Florida, and Missouri as well as the District of Columbia are enacting new laws and supporting stronger efforts to catch fraudulent claims. How are fraudsters caught?

In some cases, “whistle blowers” alert officials to those making fraudulent claims. Someone working at a clinic, hospital, or other business finds out about the fraud being perpetrated and reports it. Other cases are caught by governmental anti-fraud units that find suspicious patterns like one provider in North Carolina who bilked the system out of $45,000 for “miscellaneous” prosthetic limbs.

Increasingly, enforcers are discovering that they already have access to data that, properly analyzed, can highlight wrongdoing. Neil Versel recently wrote in FierceHealthIT that “the Obama administration is pushing high-tech in its pursuit of fraudsters, sending out ‘bounty hunter auditors’ to find waste, fraud and abuse in Medicare and Medicaid.” The “bounty hunters” are planned to be private auditors who would electronically analyze billing data for signs of fraud. They will be paid with a portion of the funds that the government recovers.

It’s not hard to predict that identity resolution technology will become a key weapon in this war against healthcare fraud. We’ve decided to start covering the latest efforts of the U.S. and state government agencies to stop the fraud and restore the funds to government coffers.