NCJ Number
109856
Date Published
1986
Length
43 pages
Annotation
This report presents data on the expenditures and activities of State Medicaid fraud control units and suggests changes that could strengthen their fraud control efforts.
Abstract
Information was obtained from quarterly statistical data submitted by the fraud units to the Department of Health and Human Services and a questionnaire sent to the 36 certified units operating in fiscal year 1985. In fiscal year 1984, the fraud units cost a total of about $43 million; and in fiscal year 1985 the units cost about $47 million. Data on fraud unit results for fiscal years 1984 and 1985 cover cases opened and closed, matters reviewed, number of providers convicted, number receiving jail sentences, fines and restitution imposed and collected, and Medicaid overpayments. There was some evidence reported by units that their activities had deterrent effects. Among the suggestions for improvements offered by unit administrators were that fraud units be allowed to investigate Medicare fraud in addition to Medicaid fraud, that the Medicaid reimbursement system be improved to check for fraud before a provider's claim is paid, that patient abuse statutes be improved at the Federal level, and that potential fraud case referrals from the State Medicaid agency to the unit be improved. Appended data, 2 figures, and 2 tables.