The Office of Inspector General conducted an audit on the Medicare-Medicaid Data Match Program, finding the initiative to collaboratively fight fraud resulted in limited returns.
In 2007 and 2008, 10 states participated in the Medi-Medi program. It received $60 million in appropriations and recouped or avoided $57.8 million in inappropriate payments. Of that $57.8 million, a combined total of $37.9 million was attributable to only Medi-Medi activities in only three of the 10 states.
Medi-Medi also produced 66 fraud referrals, 27 of which were accepted by law enforcement. A single state produced 41 percent of those total 66 fraud referrals.
The program's results tipped in Medicare's favor, as there were more fraud referrals and a larger amount of Medicare recoupments. Of the $46.2 million in Medicare and Medicaid expenditures recouped, $34.9 million was for Medicare.
The OIG has recommended CMS reevaluate the goals, structure and operations of the program. CMS responded that since the OIG's review, it has made "significant strides in enhancing the effectiveness" of the program, but it did not provide data to illustrate these enhancements.
Senators Ask Marilyn Tavenner About Her Fraud-Fighting Plans
Senators Call for Better Metrics to Assess CMS' Predictive Modeling Program for Fraudulent Claims
In 2007 and 2008, 10 states participated in the Medi-Medi program. It received $60 million in appropriations and recouped or avoided $57.8 million in inappropriate payments. Of that $57.8 million, a combined total of $37.9 million was attributable to only Medi-Medi activities in only three of the 10 states.
Medi-Medi also produced 66 fraud referrals, 27 of which were accepted by law enforcement. A single state produced 41 percent of those total 66 fraud referrals.
The program's results tipped in Medicare's favor, as there were more fraud referrals and a larger amount of Medicare recoupments. Of the $46.2 million in Medicare and Medicaid expenditures recouped, $34.9 million was for Medicare.
The OIG has recommended CMS reevaluate the goals, structure and operations of the program. CMS responded that since the OIG's review, it has made "significant strides in enhancing the effectiveness" of the program, but it did not provide data to illustrate these enhancements.
More Articles on Medicare and Medicaid Fraud:
OIG Report: Healthcare Reform, Fraud Among Top Challenges Facing HHSSenators Ask Marilyn Tavenner About Her Fraud-Fighting Plans
Senators Call for Better Metrics to Assess CMS' Predictive Modeling Program for Fraudulent Claims