Dr. Oz Demands States Take Action On Medicaid Fraud

Authored by Zachary Stieber via The Epoch Times (emphasis ours),

The head of the Centers for Medicare and Medicaid Services (CMS) demanded that states across the nation take action to crack down on fraud in Medicaid, one of the federal government’s health insurance programs.

In letters to state Medicaid directors, CMS Administrator Dr. Mehmet Oz said they should develop and file with his agency a comprehensive strategy to ensure that Medicaid providers are legitimate.

“Corrupt individuals and organizations masquerading as health care providers are defrauding Medicaid, and American taxpayers, of billions of dollars each year, placing valuable resources out of reach for those the program was intended to serve: low-income senior citizens, children, and disabled individuals,” Oz wrote.

Oz had recently previewed the effort, saying it would involve proving whether the providers “actually exist.”

“I love Medicaid; I cannot say that more fervently,” Oz said at a summit held by Politico. “If you love something, you protect it. You don’t let it get defrauded. You don’t let it get taken advantage of.”

If states do not take action, then audits may be an option, he said.

CMS has been investigating Medicaid and Medicare, and officials have said they have identified billions in fraudulent or potentially fraudulent spending, leading to actions such as deferring $259 million in payments to Minnesota. They have had to clarify some claims, including acknowledging an error in calculations regarding New York.

The new letters said CMS is acting under its responsibilities outlined in federal law, including the Social Security Act, and that CMS understands that states face challenges administering the complex Medicaid program. Oz said in the letters that CMS analyses are suggesting “a persistent and growing Medicaid threat posed by sophisticated actors knowingly exploiting these complex systems for financial gains.”

“A foundational element of Medicaid program integrity is ensuring that only legitimate, qualified providers are enrolled and participating in the program,” Oz said. “Confirming that each state maintains accurate and regularly updated provider enrollment information is a critical foundation of CMS' efforts to safeguard Medicaid program integrity, as it supports effective screening, monitoring, and oversight of participating providers.”

States were instructed to notify CMS of revalidation plans within 10 days and to follow up within 30 days with the strategy to make sure that providers are valid. It did not include any audit threats for noncompliance.

CMS declined to comment on the letters.

Oz added in a video statement that criminals are costing billions in taxpayer funds each year, and taking resources away from the needy.

“Here’s the bottom line: It’s time to make sure that providers of high-risk services are valid and meet all the requirements to deliver care to Medicaid beneficiaries,” Oz said in the video.

States have the ability to define which providers are high-risk, which might include providers without national identifiers, according to Oz.

“These are the gaps that criminals, including foreign nationals, exploit,” he said. “Revalidation works. It forces accountability, it removes bad actors, and it sends a clear message that the Medicaid system is not an unguarded piggy bank.”