The Office of Inspector General's aggressive Medicaid fraud-fighting methods don't sit well with many physicians, especially a tactic in which reimbursement is suspended, according to a New York Times report.
The Patient Protection and Affordable Care Act includes a provision called Credible Allegation of Fraud, which authorizes states to halt Medicaid payments if fraud allegations have "indicia of reliability," according to the report. Fraud investigators can freeze payments to a provider once they have a "preponderance of evidence" and then continue investigations. So far this year, the OIG has placed payment holds on 88 providers.
Part of this is due to new Deputy Inspector General Douglas Wilson's style of enforcement, in which the government immediately cuts off money to questionable providers at the first sign of a problem instead of performing lengthy investigations to pursue criminal prosecution.
Physicians and providers say this practice can bring their practice to an abrupt halt. One physician in the report said it is like "having an atom bomb dropped on [his] business" as he awaits results of a months-long Medicaid fraud investigation. Physicians also say CAFs place burdens and restrict care for their Medicaid patients.
Others say physicians have too little due process under the new Medicaid fraud strategy. Physicians facing allegations of fraud have a difficult time getting a preliminary hearing with the state, but the OIG maintains providers can come in for informal reviews at any time.
Feds Charge 48 in Alleged New York Medicaid Fraud Ring
GAO: Medicaid Fraud Audits Cost 5 Times What They Recover
The Patient Protection and Affordable Care Act includes a provision called Credible Allegation of Fraud, which authorizes states to halt Medicaid payments if fraud allegations have "indicia of reliability," according to the report. Fraud investigators can freeze payments to a provider once they have a "preponderance of evidence" and then continue investigations. So far this year, the OIG has placed payment holds on 88 providers.
Part of this is due to new Deputy Inspector General Douglas Wilson's style of enforcement, in which the government immediately cuts off money to questionable providers at the first sign of a problem instead of performing lengthy investigations to pursue criminal prosecution.
Physicians and providers say this practice can bring their practice to an abrupt halt. One physician in the report said it is like "having an atom bomb dropped on [his] business" as he awaits results of a months-long Medicaid fraud investigation. Physicians also say CAFs place burdens and restrict care for their Medicaid patients.
Others say physicians have too little due process under the new Medicaid fraud strategy. Physicians facing allegations of fraud have a difficult time getting a preliminary hearing with the state, but the OIG maintains providers can come in for informal reviews at any time.
More Articles on Medicaid Fraud:
Massachusetts Contracts Company to Detect Medicaid Fraud as it HappensFeds Charge 48 in Alleged New York Medicaid Fraud Ring
GAO: Medicaid Fraud Audits Cost 5 Times What They Recover