OIG Uncovers Flaws in CMS Processes, Programs

Few fraud referrals
In comparison, each state averaged 0.5 Medicaid referrals to law enforcement per year; law enforcement accepted an average of 0.2 referrals per state per year, according to the report. As a result of these findings, the OIG recommended that CMS reevaluate the goals, structure and operations of the Medi-Medi program to determine what aspect of the program, if any, should be part of CMS’ overall program integrity strategy.

CMS agreed with the OIG’s assessment, stating that since the period of the review, it has made significant strides in enhancing the effectiveness of the Medi-Medi program, but the OIG states that CMS has yet to provide any data to illustrate the enhanced effectiveness of the program.

Providing this data would enable Congress to make an informed decision whether to continue to fund the program and enable State and Federal agencies to make an informed decision on whether to participate.