State Senator Files Bill to Reduce Medicaid Fraud

By Yuan Ma
BU News Service

BOSTON —In order to catch Medicaid scammers before they receive payment for fraudulent claims, Massachusetts state Sen. Richard Moore proposed legislation requiring the use of technology to snare false filings.

“With more technology, we may be able to detect even more fraud,” said Moore, D-Uxbridge, whose bill encourages using and developing systems to scrutinize bills before they are paid “rather than trying to recover spent funds.”

Moore’s bill would require MassHealth to implement technology, strategy or systems, such as provider data verification, and clinical code editing to ensure that information sent for reimbursements is not false.

It also mandates an annual report from the office of Health and Human Services to report on the status of new technology and the actual and projected savings created by implementation of such technology.

The federal government spends $2.7 trillion a year on health care. The FBI has estimated that $80 billion goes to fraudulent claims each year. Departments of Justice and HHS recovered $4.2 billion in fiscal year 2012, according to the press release from their offices.

Massachusetts spent $11 billion on Medicaid in fiscal year 2013. The Medicaid Fraud Division has recovered over $200 million for the Massachusetts Medicaid program since 2007.

“If the bill becomes law, and if the required study indicates a significant savings, then the taxpayers will benefit by saving money, including the cost of court to recover funds, and the credibility of the Medicaid program will be strengthened,” Moore said.

Apart from Massachusetts, 17 states have introduced more than 35 similar bills this year.

This article first appeared on the Milford Daily News.

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