tahliagunn
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- Jun 24, 2014
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Heres some cheerful news: States and the federal government are doing little to stop a costly form of Medicaid fraud, according to a government report released last week.
Medicaid, the federal-state health insurance program for poor Americans, now covers more than half its members through whats known as Medicaid managed care. States pay private companies a fixed rate to insure Medicaid patients. It has become more popular in recent years than the traditional fee for service arrangement, in which Medicaid programs reimburse doctors and hospitals directly for each service they provide.
Despite the growth of managed care in recent decades, officials responsible for policing Medicaid did not closely examine Medicaid managed-care payments, but instead primarily focused their program integrity efforts on [fee-for-service] claims, according to the Government Accountability Office, the investigative arm of Congress. The managed-care programs made up about 27 percent of federal spending on Medicaid, according to the GAO. The nonpartisan investigators interviewed authorities in California, Florida, Maryland, New Jersey, New York, Ohio, and Texas over the past 12 months.
Medicaid, the federal-state health insurance program for poor Americans, now covers more than half its members through whats known as Medicaid managed care. States pay private companies a fixed rate to insure Medicaid patients. It has become more popular in recent years than the traditional fee for service arrangement, in which Medicaid programs reimburse doctors and hospitals directly for each service they provide.
Despite the growth of managed care in recent decades, officials responsible for policing Medicaid did not closely examine Medicaid managed-care payments, but instead primarily focused their program integrity efforts on [fee-for-service] claims, according to the Government Accountability Office, the investigative arm of Congress. The managed-care programs made up about 27 percent of federal spending on Medicaid, according to the GAO. The nonpartisan investigators interviewed authorities in California, Florida, Maryland, New Jersey, New York, Ohio, and Texas over the past 12 months.
