States Seek Medicare Data to Keep Fraudulent Providers Out of Medicaid

Govtech.com: 6/25/2012.

Glenn Prager used to be a Medicare fraud fighter for the federal government. Early this year he switched to Medicaid, taking a job as Arizona’s inspector general. His primary task is to keep crooked health-care providers out of the state’s $9 billion Medicaid system. If they slip in under the wire, he says, the goal is to catch them before any claims are paid.

But six months into his new role, Prager is frustrated that he can’t get his hands on the Medicare data he used when he was a federal investigator. “The basic problem,” he says, “is a lack of coordination and communication between the two programs. There’s no other way to explain it.”

Prager is not alone in his complaints. The National Association of Medicaid Directors released a report last month calling on the federal government to share Medicare data and improve collaboration with states in their mutual battle to reduce Medicaid fraud and abuse. Congress and the federal Government Accountability Office are also pushing the U.S. Department of Health and Human Services to provide better support for state fraud-busting efforts. Read More