Home Health & Hospice Week

A year into its Medicaid Program Integrity Strategy, the Trump administration is ready to claim some successes and outline future PI-boosting initiatives.

“The Medicaid program has grown from $456 billion in 2013 to an estimated $576 billion in 2016, largely fueled by a mostly federally financed expansion of the program to more than 15 million new working age adults,” Centers for Medicare & Medicaid Services Administrator Seema Verma says in a June 25 post on the CMS blog. “For these adults, the estimated cost per enrollee grew about 7 percent from FY2017 to 2018, compared to about 0.9 percent for other enrollees. With this historic growth comes a commensurate and urgent responsi­bility by CMS on behalf of the American taxpayers to ensure sound stewardship and oversight of our program resources.”

The successes: Verma touts enhanced data sharing and collaboration to detect fraud and abuse; education to states on “promising practices” regarding “fraud and abuse referrals” and “high-risk providers;” the Healthcare Fraud Prevention Partnership data- and information-sharing program between 41 state and local partners; $900 million in disallowances CMS made after states haven’t returned federal funds associated with unallowable claims; and increased eligibility audits in California, New York, Kentucky, and Louisiana.

Future initiatives: CMS plans to begin Targeted Probe and Educate reviews for Medicaid claims; to offer Comparative Billing Reports for Medicaid services; and to conduct provider screening on behalf of states for Medicaid-only providers, among other measures.