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Medicaid directors want in on integrity efforts

By , - Last modified: October 18, 2012 at 9:04 AM

Federal efforts to stop fraud and waste in Medicaid could be more successful if they involved the state programs, according to the National Association of Medicaid Directors.

NAMD sent the Centers for Medicare and Medicaid Services a letter on Oct. 5, requesting "a new effort to work together" and saying ongoing flaws in collaboration and communication "have been undermining the success of program integrity efforts."

"The most recent example of this was the announcement that the Departments of Health and Human Services and Justice had launched a public-private partnership to prevent health care fraud," NAMD wrote. "The planning for and launch of the initiative lacked any notable consultation with state Medicaid programs."

NAMD noted that in March it issued a report on Medicaid program integrity from a state perspective, including several recommendations. The letter requested several additional collaborative actions, including the following:

• Giving states access to the CMS fraud investigations database and allowing them to contribute data to it. "If a provider is inappropriately billing one system, they are likely taking advantage of multiple systems," NAMD wrote. "Ensuring states have access to this information would be extremely beneficial to Medicaid fraud prevention and detection efforts."

• Working with states to develop a screening and verification program for Medicare and Medicaid providers that shares information and avoids duplication. Many providers are in both Medicare and Medicaid programs, NAMD wrote, but programs CMS contracts with to screen Medicare providers currently don't have to share their results with the states.

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