CMS Launches Effort to Fight Medicaid Fraud and Abuse

Medicaid Integrity Program: New Measures Against Fraud and Abuse

CMS announced on July 18, 2006 a new comprehensive effort to detect and prevent program fraud and abuse focused on Medicaid. Called the Medicaid Integrity Program ("MIP"), the new effort will be designed to combat theft, inappropriate use of funds and simple mistakes that drain critical Medicaid dollars.

The new MIP was created by the Deficit Reduction Act of 2005 with funds that will rise from $5 million in 2007 to $75 million by fiscal year 2009 and each year thereafter. Congress has mandated both the use of contractors and at least 100 full-time staff to implement the MIP. These resources will be focused on conducting audits, identifying overpayments and educating providers on Medicaid program integrity and quality of care.

The resources that the government will now use to combat Medicaid fraud means that providers will be under greater scrutiny over the accuracy of Medicaid claims. Coupled with the Deficit Reduction requirements which encourage states to adopt false claims legislation and require providers to educate their workforces about false claims statutes and whistleblower protections, it is clear that Medicaid will soon become a principal focus of enforcement actions by both the government and qui tam realtors. Existing compliance activities must be scrutinized to assure that providers are prepared for the new government focus on Medicaid.