Medicaid is now one of the top audit and enforcement priorities of state and federal governments. Medicaid Fraud Crackdowns and Compliance explains what sparked this enforcement push, how it affects providers and what actions your organization should take now.

After years of ballooning Medicaid spending undermined by inadequate oversight, Congress unleashed a torrent of federal money aimed at reining in fraud and abuse, and enacted the the federal Deficit Reduction Act (DRA). The DRA mandated the creation of the Medical Integrity Program at CMS, increased funding for Medicaid fraud fighting at the HHS Office of Inspector General, gave states incentives to enact false claims laws, and required training of employees on the False Claims Act and its whistle-blower provisions.

Medicaid Fraud Crackdowns and Compliance is packed with case studies that will show you what health care organizations should expect under the DRA. It will help prepare you for the waves of newly funded Medicaid auditors likely heading your way, and federal and state enforcers working more closely together to build fraud cases against suppliers, providers and pharmaceutical manufacturers.

Get practical advice on complying with the DRA requirements. Order your copy of Medicaid Fraud Crackdowns and Compliance today!

Table of Contents Introduction

1. Medicaid Fraud in the Crosshairs
   • Congress Targets Medicaid Fraud in Deficit Reduction Bill, Funds Gain-Sharing Demo
   • With DRA Rule, Tell Employees False Claims Lawsuit Is Last Resort; Preach Compliance
   • Medicaid Is a Top OIG Target; Expect Changes in Integrity Agreements, Self-Disclosure
   • States Turn Up Medicaid Enforcement Heat; Texas Officials Recoup $10 per $1 Spent
   • CMS Launches Attack on Medicaid Fraud; Expert Urges Hospitals to Boost Monitoring
   • DOJ: Systemic Fraud, Not Technical Violations, Targeted; Hospitals Still a Priority
   • Judge Rules That MCO Must Pay More Than $334 Million in FCA Case
2. Laying the Groundwork With Guidance
   • DRA False Claims Training Guidance Anticipated; Hospitals Try to Balance Message
   • Policy for DRA Training Mandate
   • Compliance With DRA Training Requirements
   • Handbook Insertion and the DRA Mandate: Teaching Employees About the False Claims Act
   • Guidance on DRA-Mandated False Claims Training Sheds Light, Stimulates Questions
   • New CMS Guidance Provides Details of DRA Training, Eases ‘Adoption’ for Contractors
3. States Have Big Incentive
   • OIG Rejects Seven State False Claims Laws for DRA Bonuses
   • CMS to Reconsider Contractor Obligation Under DRA False Claims Training Mandate
   • State Enforcer: Gear Up Now for Medicaid Crackdown Before Slew of Audits Hits Soon
   • Fraud Enforcement Remains Hot; Expect More Kickback, Stark Cases
   • OIG Approves Two State False Claims Law for DRA Bonuses
   • Watch Out, N.Y.: Sheehan Takes Top Medicaid Job; Model May Spread

Written For

• Hospitals, health systems and other providers
• State government health care officials
• Managed care companies
• Other facilities

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