Watchdog Promotes Cooperative Anti-Fraud Effort

A recent decision by federal authorities to promote closer cooperation among Medicaid anti-fraud contractors is resulting in an increase in dollars saved, according to a new report from the Office of the Inspector General (IG) of the U.S. Department of Health and & Human Services. The IG’s Office examined savings achieved by the federal Medicaid Integrity Program, created by Congress in 2005 to attack fraud, waste and abuse in state-based healthcare services for the poor. The Program created two groups of contractors: Review Medicaid Integrity Contractors-Review MICs-that identify potential overpayments and Audit Medicaid Integrity Contractors-Audit MICs-that focus in on specific targets based on initial review findings and after additional analysis by state and federal authorities. Analysis by the IG’s Office for a six-month period ending in June 2010 found that “collaborative audits” including input and cooperation from all involved parties accounted for $6.2 million of a total of $6.9 million in identified overpayments. The IG’s Office said the $6.2 million was recovered via seven collaborative audits, as opposed to the $700,000 in overpayments identified by 35 audits conducted in isolation. The U.S. Center for Medicare & Medicaid Services, which manages the Medicaid Integrity Program, has endorsed the IG’s Office findings, noting that while it had assigned only 8 collaborative audits in the first 6 months of 2010, it had assigned 83 such audits for the 18 months since the IG’s review period. IPRO is identified in the report as one of only two Audit MIC contractors currently operating nationwide. To access the report, Early Assessment of Audit Medicaid Integrity Contractors (March 2012, OEI-05-10-00210), visit the IG website at http://oig.hhs.gov.