Medicare Compliance & Reimbursement

Contractor audits, payment scrutiny ensues.

At least 100 full-time Centers for Medicare & Medicaid Services (CMS) staff will be collaborating with state officials to scrutinize your Medicaid billing practices.

In an "unprecedented" effort to fight Medicaid fraud, CMS announced on July 18 that it is launching the Medicaid Integrity Program (MIP), which the Deficit Reduction Act of 2005 (DRA) created. "The program we are initiating today builds upon expanded activities to combat fraud in the Medicare program that have proven successful in the past few years, as well as recent congressional action on our request for additional funding to protect the Medicaid program," CMS administrator Mark McClellan said in the July 18 announcement.

The DRA provided funding for the MIP, which will increase from $5 million in 2007 to $75 million by fiscal year (FY) 2009, CMS says. Congress requires the program to use contractors to review providers' actions, "conduct audits, identify overpayments and educate providers and others on program integrity and quality of care," CMS notes. The agency must also devote at least 100 full-time staff, which will collaborate with state Medicaid officials, to the MIP, pursuant to congressional mandates.

"The MIP will also closely coordinate with the Medicare Program Integrity group on projects such as Medi-Medi, a pilot project to share data to detect improper billing and utilization patterns and the Payment Error Rate Measurement Program, which is designed to calculate Medicaid payment error rates," CMS says.

To read the announcement, go to www.cms.hhs.gov/apps/media/press/release.asp?Counter=1900.