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Thu Jun 14, 2012, 12:11 PM

Medicaid Fraud Audits Cost Five Times Amount U.S. Found [View all]

By Alex Wayne - 2012-06-14T04:01:00Z

A program to fight fraud in the Medicaid health system for the poor has cost the U.S. at least $102 million in auditing fees since 2008 while identifying less than $20 million in overpayments, investigators found.

The majority of the audits conducted by 10 companies were discontinued, produced “low or no findings” or were “put on hold,” the Government Accountability Office, the nonpartisan investigative arm of Congress, said today in a report. Three companies won’t have their contracts renewed, and two others will be reassigned, said Peter Budetti, the director of program integrity at the Centers for Medicare and Medicaid Services.

“The results were extremely disappointing, way below what the expectations had been,” Budetti said in a telephone interview. He declined to name the companies terminated because he wasn’t sure whether the actions have been made public.

Medicaid and Medicare, the U.S. insurance program for the elderly and disabled, are plagued by $60 billion in fraud a year, the Justice Department estimates. The Medicaid audit program, which was supposed to identify erroneous payments to doctors and hospitals, has produced “a negative return on investment,” aides to Senator Tom Carper, a Delaware Democrat, said in a staff memo to the Senate Homeland Security and Governmental Affairs committee.



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