King trails most in Medicaid fraud recovery
Only Alaska had a worse record than New Mexico, according to the newspaper. Leading the pack was Missouri, which recovered more than $31 for each $1 spent. The national average was a recovery of $10 for every $1 spent.
From the newspaper:
“If New Mexico’s Medicaid fraud unit had performed just average when compared with units in other states, it would have collected $18.5 million from criminal and civil defendants in the 2010 federal budget year. Instead, it brought in less than $1 million while spending about $1.8 million on its operation.
“And, just so you know, there is a lot of Medicaid fraud going on in New Mexico.
“By one estimate, there is about $75 million worth of fraud each year, and providers – those are the folks the AG’s Medicaid fraud unit is supposed to go after – account for 80 percent of the $75 million.”
Here’s King’s response:
“The AG noted that the responsibilities of the Medicaid fraud unit include investigating and prosecuting elder abuse but said such cases typically don’t produce a financial recovery.
“…Also in his response, King said New Mexico generally recovers less in Medicaid fraud than other states because of its heavy reliance on managed care organizations to deliver benefits.
“The AG agreed with the review that the Medicaid fraud unit and the Human Services Department, which runs Medicaid, need to communicate better on referrals.”
“King also agreed to conduct an internal review of how the unit prioritizes cases and allocates staff.”
Read the full article here.
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