Healthcare providers banned from Medicaid may have been reimbursed $213 million in federal money, thanks to a state agency oversight, a government watchdog reported.
Valid identification numbers — identifiers that ensure providers are eligible for Medicaid reimbursements — were missing from 800,000 Colorado claims in 2011, the U.S. Department of Health and Human Services inspector general reported Wednesday.
The state reimbursed the providers $424.4 million for the claims, of which, $213 million was federal money.
"Medicaid claims submitted for reimbursement that do not have [identification numbers] are thus more vulnerable to improper payments," the report said. "In fact, it is possible that the state agency paid claims that had been submitted by federally banned providers."
Federal law requires that Medicaid claims must include valid identification numbers. Providers can be banned for reasons such as committing fraud.
Investigators reported that more than 798,000 of the 2011 claims totaling at least $212.1 million in federal money were missing identification numbers. Another 4,700 claims totaling about half a million dollars in federal money had identification numbers that did not match any provider.
The providers were reimbursed because Colorado's claims processing software didn't alert officials of invalid or missing identification numbers, the inspector general found.
make those responsible repay out of their own corrupt pockets!!!!! They surely pocketed a portion of the graft money themselves, they always do!!!!!
This truly makes me sick. I hope when people pull off this fraud they realize this is the money of the tax payer.
In all Public Organizations, Federal, State, County, Cities, using 'Public Dollar's' should be helt to a 'higher standard' of Zero Tolerance. Private Organizations, standards of fiscal control, will be set by their Boards, Shareholders, etc.
Does, it surprise me about the 'lack or delayed, oversight of Public Agencies! No! With lack of Oversight, there can be 'breeding grounds' for 'Fraud, Waste and Abuse.' So, yes everyone, involved with Spending is to blame for FWA, but the Overseer's, are the 'most to blame'. Why? Simple, they are not 'doing their jobs'! If, they are over burden, then 'kick the cause' upstairs. Get the 'Tool's, to support what ever is their mission. As, a Taxpayer (not by far, the only one) its not Fair for other's to 'waste' funds or resources, these items, can be put to better use! Can we blame, the One's who violated the Rules/Regulations, Sure! Can they recoup those missing Millions, Sure they can! But, does it Cost more to recover those funds?
As, a former controller of Public Funds, as additional Duty, it was one of the 'few' additional duties, that could get me jail time! Did I take it seriously, you betcha! As, a 'Auditor' other duty as assigned, I found and recovered several 'abuses' of Travel Voucher's. For Everyone of us, that took all of our Duties, seriously, there was other's not so serious! Eventually, the systems of 'Check and Balances' worked, but it took Work and Oversight! "If you as a 'department' can't get the job done, quit and find a 'department' that can, there is no room for one dollar of Public Money, to be wasted. Inspector General's of the USA Governance's, 'get the lead out, break the Routine of 'this is how we always did it', change Ways of Management, follow the Rules and Regulations, as written (plus Spirit of the Law) or change the one's not working and the Attitudes will follow! I'm positive, maybe? 2015
If we did that we would be in jail.
I am sure that this estimate is low.