GAO hits Medicaid on waste

Politico ^ | 12/11/12 5:06 AM EST | By JENNIFER HABERKORN

[DeaconBenjamin]

The Medicaid program has government employees and contractors doing some of the exact same work, which is wasting government time and money, according to a new Government Accountability Office report released Monday.

Medicare, meanwhile, could better use data programmed into claims processing systems to stop fraud, GAO said in a separate report.

GAO made the recommendations in reports requested by Sens. Tom Carper (D-Del.), Tom Coburn (R-Okla.) and others. The reports come as lawmakers are likely to look to both programs for potential savings in the fiscal cliff negotiations and are part of the constant effort on Capitol Hill to reduce waste in both programs.

Medicare is estimated to have made $28.8 billion in improper payments in 2011, according to GAO. Medicaid was estimated to have made $21.9 billion in bad payments — a higher percentage of its outlays than Medicare’s bad payments because it is a smaller program.

The reports “lay out some specific changes to Medicare and Medicaid that can help save taxpayers millions of dollars by improving oversight to identify, and ultimately prevent, fraudulent and wasteful Medicare and Medicaid payments,” Carper said.

GAO said the Medicaid Integrity Group of the Centers for Medicare & Medicaid Services hired contractors to do the exact same work it was doing under its National Medicaid Audit Program, which is designed to catch waste and fraud.

“Because both types of contractors had to assess whether payments were improper under state Medicaid policies, having separate contractors doubled states’ burden in ensuring that state policies were being correctly applied,” the report said, adding that the double work wasted government money and made the audits last longer.

“GAO’s work once again highlights how ineffective the federal government is at addressing waste, fraud and abuse in our health care programs,” said Sen. Scott Brown (R-Mass.), who, along with Sen. John McCain (R-Ariz), joined Carper and Coburn on the Medicare report.

The Department of Health and Human Services, in a response to the report, largely agreed with the assessments and said it’s in the process of strengthening the Medicaid anti-fraud efforts, in part to respond to the expected expansion of the program next year under health reform. But HHS said it didn’t agree with all of GAO’s recommendations, including eliminating a state reporting requirement that GAO found duplicative but HHS said had important data.

On Medicare, GAO recommended that CMS strengthen the use of pre-payment edits, controls that are programmed into claims processing to screen for potentially fraudulent activity. GAO said Medicare needs to restructure some of the data and make it easier to use. HHS generally agreed.

[andyk]

Gosh, who knew? Don’t we “discover” the same thing about medicare/medicaid like every year?