NCJ Number
80215
Date Published
1980
Length
69 pages
Annotation
This report discusses the effectiveness of State medicaid fraud control units and what actions the U.S. Department of Health and Human Services (DHHS), should take to improve program operation and administration.
Abstract
To help reduce medicaid fraud, in 1977 Congress enacted the Medicare-Medicaid Anti-Fraud and Abuse Amendments authorizing 90-percent Federal matching payments, instead of the normal 50, for fiscal years 1978-80 as an incentive to States to establish medicaid fraud control units. DHHS's Office of the Inspector General is responsible for certifying, funding, and monitoring the fraud control units. As of April 30, 1980, 30 States and the District of Columbia had certified fraud units. The General Accounting Office (GAO) reviewed seven of these units. GAO believes that it will be extremely difficult for State fraud units to become self-supporting after September 30, 1980. However, these units have increased States' ability to investigate and prosecute medicaid fraud. Fraud units also deter medicaid providers from attempting fraud and have had an impact on changing State legislation and medicaid regulations to make it easier to identify fraud and provide more stringent penalties. GAO believes that fraud units can be an effective force in combating medicaid fraud and that their effectiveness should increase as they gain experience in investigating and prosecuting medicaid fraud. GAO recommends that Congress should provide funding for State medicaid fraud units beyond September 1980. Such legislation should require HHS to annually certify for continued funding only those units that have demonstrated effective performance based on reasonable performance standards established by DHHS. The report also discusses hindrances to more effective operation of fraud units and offers recommendations to DHHS. Agency comments, a list of abbreviations, a letter, and a table are included. (Author summary modified)