Congress sets sights on Medicaid fraud for 2000

Congress is likely to step up its efforts to reign in fraud and abuse in the Medicaid program when it returns next year. "In the Medicaid program alone, the cost of fraud and abuse may exceed $17 billion every year," House Commerce Committee Chairman Rep. Tom Bliley (R-VA) asserted at a Subcommittee on Investigations and Oversight hearing Nov. 9.

The General Accounting Office's (GAO) Leslie Aronovitz told the subcommittee that the Medicaid program's size and structure make it inherently vulnerable to exploitation. "Fraud schemes often cross state lines and enforcement jurisdictions, entailing a number of federal, state, and local agencies that may have different or competing priorities in their efforts to investigate, prosecute, and enforce compliance."

"The magnitude of fraud and abuse in the Medicaid program has not been quantified. Fee-for-service providers do not have a monopoly on fraudulent and abusive health care practices," Aronovitz told the subcommittee. Under managed care, providers intending to exploit the program have adapted to new financial incentives, she added.

While promoting the Health Care Financing Administration's (HCFA) overall effort at curbing Medicaid fraud, Penny Thompson, director of HCFA’s Program Integrity Group, told the subcommittee that HCFA is now working with states to develop systems to measure their progress.

She said HCFA has developed clear guidance to review state agency program integrity efforts, both in fee-for-service and managed care. She added HCFA also plans to send a national review team to conduct a targeted evaluation of anti-fraud efforts in eight states selected to represent a cross section of state Medicaid programs in January 2000.