CMS will require all states to audit healthcare providers participating in Medicaid in an effort to address alleged fraud, Politico reported April 21.
Administrator Mehmet Oz, MD, unveiled the plan at Politico’s Health Care Summit. CMS will require all states to submit a plan within 30 days outlining how they will verify that healthcare providers are real, licensed and actually delivering care under Medicaid, particularly in areas flagged as high risk for fraud.
“We’re asking the states to own that problem … red and blue, all of them,” Dr. Oz said at the summit, according to Politico. “If you don’t take it seriously, it indicates to us that we might have to take the audits … more aggressively.”
The announcement comes as the White House has expanded its Medicaid fraud crackdown to Florida, following a March 17 letter from Dr. Oz to Gov. Ron DeSantis and other state leaders requesting information on how the state identifies, prevents and addresses Medicaid program integrity issues.
The House Committee on Energy and Commerce sent letters March 3 to 10 other states requesting information on fraud, waste and abuse in their Medicaid programs: California, Colorado, Massachusetts, Maine, Nebraska, New York, Oregon, Pennsylvania, Vermont and Washington. For his part, Dr. Oz has sent letters to California, Florida, Maine and New York alleging Medicaid fraud in their programs, Politico reported.
Susan Baumgaertel, MD, an internist, practice owner and patient advocate at myMDadvocate, recently connected with Becker’s to share her thoughts on how the new fraud crackdown policy may affect physicians at the state level.
Editor’s note: This response has been lightly edited for clarity and length.
Question: How do you think this new policy will impact ASCs and physicians in your state? How can leaders prepare for its implementation?
Dr. Susan Baumgaertel: Under the new CMS rule, physicians would be subjected to state audits, having to prove who they are, even though that’s already a part of state medical licensure overview. Redundancy has a cost. There is so much more fraud and waste in the healthcare system elsewhere; this is not the low-hanging fruit [Dr.] Oz thinks it is. Going after physicians adds more burden to all involved, in an era where it’s getting more and more difficult for patients to access care. It would be far more lucrative to continue scrutinizing insurance fraud around [hierarchical condition coding]-related upcoding and billing.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
