WASHINGTON – As part of the Deficit Reduction Act of 2005, Congress appropriated $50 million each year in fiscal years 2007 and 2008 and $75 million for 2009 and each subsequent year for the Centers for Medicaid and Medicare Services to combat fraud, waste and abuse and to create a national strategy to deal with these issues.
CMS recently took its first steps in this area by awarding two of its five Medicaid Integrity Program (MIP) contracts.
Health Management Systems’ (HMS) award of a Medicaid Integrity Contract deems the company a qualified auditor. HMS provides cost containment, benefits coordination and program integrity services such as auditing and clinical review for government healthcare programs, including Medicaid programs in 40 states and 72 Medicaid managed care plans.
MIP auditors will be looking at individual Medicaid providers through audited samples of claims to make sure services rendered were necessary.
“The findings that we develop would be turned over to the states, which would ultimately get the benefits,” said Robert Holster, CEO and chairman of HMS.
Medicaid expenditures are increasing 7 percent to 8 percent annually, according to Holster. While admitting the difficulty of fundamentally changing any system, especially given the multiple constituencies involved in the case of state Medicaid programs, he said the focus, investment and response has been on “control around the edge.”
IPRO, assessors of healthcare services, was awarded a Medicaid Integrity Contract in late January. An IPRO spokesperson said the contract award was too new and the situation “in flux” to be able to comment at this time.