Strategic Actions to Curtail Medicaid Fraud

Medicare's swelling price tag might be reined in. Here are the steps taken and future actions required to restrain Medicare fraud, according to the GAO.

Enhance Provider Application Requirements
The GAO has discovered continual weak areas in the methodology employed by the Centers for Medicare & Medicaid Services (CMS), the national department that supervises Medicare and Medicaid, to register Medicare service providers. If enrollment approaches were actually bolstered, potential fraudulence could be impeded.

For instance, in early 2011, CMS established a restricted, moderate and high standard of risk for providers and established varying screening measures for each classification. However, the GAO uncovered that CMS had not performed the following actions, as stipulated by the Patient Protection and Affordable Care Act (PPACA):.

• Establish core elements with regard to compliance programs for providers.
• Disperse a regulation demanding extra provider info.
• Create background checks hinged on finger prints.
• Specify which providers would be obliged to post surety bonds, and that consequently, should ensure the recovery of falsified claims.

http://syrtissolutions.com/medicaid/critical-steps-curtail-medicaid-fraud/

Regulation Could Reduce Medicaid Abuse, Waste and Fraud

The Government Accountability Office (GAO), the guard dog for the U.S. Congress, verified that Medicaid and Medicare are programs having potential for a higher risk of abuse, waste and fraud. In the case of Medicaid, the GAO suggests substandard fiscal management might lead to improper expenses. A complex Medicare system could easily result in erroneous disbursements.

The Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS) that supervises these programs, concluded that in 2010 that over $70 billion dollars was paid out improperly. Simply by administering past GAO proposals, recently passed legislation and existing agency courses of action, the CMS could accomplish five approaches presently detailed by the GAO as approaches to decrease inappropriate Medicaid and Medicare payments, and thus helping reduce fraud.

Sustain Five Areas to Fight Medicaid and Medicare Abuse