The federal government is escalating its crackdown on Medicaid fraud and every state has been placed on notice.
On April 21, Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz announced that all 50 states will be required to submit provider revalidation plans within 30 days. Speaking during Politico’s Public Health Care Summit, Oz said that states will be called on to immediately audit and verify providers paid by their state’s Medicaid program. Oz said the revalidation audit must focus on “high risk” areas, with the goal of confirming that all Medicaid providers are “legitimate.”
Under existing federal regulations, state Medicaid agencies are required to revalidate providers at least every five years. With this initiative, CMS is requiring that states demonstrate compliance immediately. To aid this effort, CMS is instructing states to continue to use advanced technology and data analytics. “Data clues us in to where the fraud is,” Oz said. Further details on this initiative will be announced later this week.
With this announcement, it is clear that the government’s coordinated effort to root out Medicare and Medicaid fraud is not slowing. To get ahead, providers should ensure that their enrollment records are accurate and complete and should self-audit their billing and documentation practices.
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