Fraud & Abuse
Policy Statement on Fraud and Abuse
States should be encouraged to partner with Medicaid health plans to identify and curtail waste, fraud and abuse in Medicaid. With advanced claims processing systems, data reviews and analytic tools, health plans are better able to identify irregular billing patterns and find outliers that may need corrective action. MHPA supports efforts to strengthen the cooperation between states and health plans in fighting fraud. Such efforts should involve clear, consistent communications on the expectations of the plans, and should not involve additional unfunded administrative burdens. Medicaid health plans are positioned to serve as leaders in eliminating fraud and abuse in Medicaid to protect taxpayer dollars.
Policy Activity
MHPA Letter to the Senate Finance Committee on Decreasing Waste, Fraud and Abuse and Increasing Program Integrity in MedicaidOn June 28, 2012, MHPA sent a letter to members of the Senate Finance Committee on ways to cut down on waste fraud and abuse in the Medicaid and Medicare programs and increase program integrity. MHPA recommended a number of items that MHPA member plans believe will help ensure Medicaid program integrity including reducing redundancies in the provider screening process; researching and enhancing pharmacy lock-in programs; developing programs to measure fraudulent claims rates; allowing increased beneficiary restrictions for known offenders; and making available Medicare data to provide state Medicaid agencies and plans access to information in areas where there is cross-over between the two programs. Click here to read the letter.
MHPA Letter in Support of the National All Schedules Prescription Electronic Reporting (NASPER) Reauthorization ActOn November 3, 2011, MHPA sent a letter to Congress supporting the reauthorization of NASPER as part of its efforts to help reduce waste, fraud and abuse in the Medicaid program. Click here to read the letter.
MHPA Letter to HHS on Medicaid Health Plan Participation in Fraud and Abuse Prevention SummitOn November 24, 2009, MHPA sent a letter to the Department of Health and Human Services encouraging the agency to include Medicaid health plans in a planned summit on Medicare and Medicaid fraud. Deputy Secretary Bill Corr named a number of stakeholder groups that would be invited to participate in the agency's ongoing efforts to address fraud, but Medicaid health plans were not named. Click here to read the letter.
States should be encouraged to partner with Medicaid health plans to identify and curtail waste, fraud and abuse in Medicaid. With advanced claims processing systems, data reviews and analytic tools, health plans are better able to identify irregular billing patterns and find outliers that may need corrective action. MHPA supports efforts to strengthen the cooperation between states and health plans in fighting fraud. Such efforts should involve clear, consistent communications on the expectations of the plans, and should not involve additional unfunded administrative burdens. Medicaid health plans are positioned to serve as leaders in eliminating fraud and abuse in Medicaid to protect taxpayer dollars.
Policy Activity
MHPA Letter to the Senate Finance Committee on Decreasing Waste, Fraud and Abuse and Increasing Program Integrity in MedicaidOn June 28, 2012, MHPA sent a letter to members of the Senate Finance Committee on ways to cut down on waste fraud and abuse in the Medicaid and Medicare programs and increase program integrity. MHPA recommended a number of items that MHPA member plans believe will help ensure Medicaid program integrity including reducing redundancies in the provider screening process; researching and enhancing pharmacy lock-in programs; developing programs to measure fraudulent claims rates; allowing increased beneficiary restrictions for known offenders; and making available Medicare data to provide state Medicaid agencies and plans access to information in areas where there is cross-over between the two programs. Click here to read the letter.
MHPA Letter in Support of the National All Schedules Prescription Electronic Reporting (NASPER) Reauthorization ActOn November 3, 2011, MHPA sent a letter to Congress supporting the reauthorization of NASPER as part of its efforts to help reduce waste, fraud and abuse in the Medicaid program. Click here to read the letter.
MHPA Letter to HHS on Medicaid Health Plan Participation in Fraud and Abuse Prevention SummitOn November 24, 2009, MHPA sent a letter to the Department of Health and Human Services encouraging the agency to include Medicaid health plans in a planned summit on Medicare and Medicaid fraud. Deputy Secretary Bill Corr named a number of stakeholder groups that would be invited to participate in the agency's ongoing efforts to address fraud, but Medicaid health plans were not named. Click here to read the letter.
Plan to Attend MHPA 2013
Save Oct. 20-22 for MHPA 2013 at the Gaylord National Resort & Convention Center at National Harbor, MD. Our annual conference again will be the country’s largest gathering of top-level executives in the Medicaid health plan industry. For sponsorship and exhibiting opportunities at MHPA 2013, please click here.
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