NEW: Assembly Seeks to Address Medicaid Fraud
Monday, January 30, 2012
Rep. Patricia A. Serpa (D-Dist. 27, West Warwick, Coventry, Warwick) has introduced a House resolution requesting Gov. Lincoln Chafee to implement programs and methodology to improve the program integrity of both Medicaid and the Children’s Health Insurance Program (CHIP) in the state.
The House Finance Committee will hear the bill on Wednesday, Feb. 1, at 2:30 p.m. in Room 35 of the State House.
“As with everything, it’s all about having the right tools at your fingertips,” the representative said. “There have been talks about cutting services to generate a balanced budget, but there are surefire ways to save the state money and fill in the gaps here – this is one of them. We can’t continue to slash services when we haven’t taken the necessary steps here to prevent massive amounts of waste and fraud. This needs to be a top priority before we even consider taking another step forward with the budget.”
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTThe resolution (2012-H 7235) requests that the governor seek to shift the programs from a retrospective “pay and chase” model to a pre-payment model. It also asks the state Department of Human Services to implement provider data verification and screening technology solutions to check health care billing, as well as provider rendering data against a well-maintained provider information database.
Furthermore, the resolution states that the department should implement state-of-the-art clinical code editing technology solutions to enhance cost containment. The technology would be critical to preventing any kind of errors, including potential overbilling or inappropriate payments to deceased and sanctioned providers. The upgrade would also make the state capable of confirming wrong addresses and sending a red flag to the department when a provider has either retired or carries an expired license.
This month, a Woonsocket woman pleaded guilty to defrauding Medicare of more than $70,000. Representative Serpa said if the state government can catch more fraud like this in its Medicaid programs, the state could see savings in the millions. The federal government has estimated that fraud, waste and abuse have cost state Medicaid programs across the country about $18 billion annually.
“The savings that we can achieve with these adjustments will be enough to cover the cost of practicing these new measures,” Representative Serpa said. “This is a step forward the state must consider in the economic downturn. It’s not only saving the taxpayers money – it’s making government more efficient. We took a big leap with pension reform, and now we must continue to analyze our weaknesses.”
