Part B Insider (Multispecialty) Coding Alert

Published on Fri Jun 07, 2013 PDF

You should be paying attention to your claims and other data, because authorities certainly are — and state regulators could soon be doing it even more.

The OIG has finalized a rule that will allow State Medicaid Fraud Control Units to use federal matching funds to “identify fraud through screening and analyzing State Medicaid data,” the OIG says in a notice in the May 17 Federal Register.

“Most commenters supported our proposal to provide Federal reimbursement for data mining activities by MFCUs, citing potential cost savings through earlier identification of Medicaid fraud, the benefit of conserving administrative resources by better targeting of antifraud investigations, and the potential for increased effectiveness in finding and eliminating fraud and abuse,” the OIG says in the final rule.

States will have to submit a request to use funds for data mining. “A data mining request must describe how data mining will be coordinated with the State Medicaid agency and OIG approval of any request will be coordinated with CMS,” the OIG explains in a notice of the regulation.

The rule is at https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp