SPRINGFIELD – Governor Rod Blagojevich directed the Illinois Department of Public Aid (IDPA) to investigate Medicaid fraud resulting in more than $27 million in overpayments to health care providers and preventing an additional $14.2 million worth of improper payments, according to year-end estimates released today.
In line with that goal, the Governor announced that the state Medicaid fraud detection team will take part in a pilot project to share computerized data more closely with federal Medicare investigators. The new effort in 2004 should boost efforts to crackdown on health providers who try to bill both systems for the same care.
“My administration has proven that it is totally committed to delivering health care to children and families and seniors who truly need it,” the Governor said. “But at the same time, we are just as committed to being careful stewards of taxpayers’ funds. That’s why we are determined to go after anyone who cheats the system, whether they are a health care provider or an individual who is seeking care under false pretenses.”
In the Blagojevich Administration’s first year, the IDPA Inspector General’s Office (OIG) collected $27 million in funds through audits of health care providers, court-ordered restitution and Fraud Science Team investigations, the Department announced.
The Fraud Science Team uses advanced software to scan hundreds of millions of Medicaid claims to ferret out fraud. For example, the Team’s time dependent billing routine is used to identify medical practitioners who bill for more than 24 hours in a day, and has resulted in numerous indictments, audits, and other enforcement actions.
The agency estimates that it prevented the loss of an additional $14.2 million in taxpayers funds through a variety of pro-active measures, including $8 million saved through careful screening of applications and $2.2 million saved from Food Stamp disqualifications.
IDPA Director Barry S. Maram said that the new Medicare-Medicaid anti-fraud partnership – called the Medi-Medi Project – will take the agency’s fight against waste, fraud and abuse to a new level.
“By sharing data with our federal partners we are going to be able do a much better job of pinpointing providers who may be either double-billing or cheating the system in other ways,” Maram said.
The Department’s reputation for innovation in fighting fraud was one of the main reasons it was selected to take part in the Medi-Medi pilot project. Under an agreement to be formalized in early 2004, Illinois will be one of five states around the country to pool data, technology, and expertise to fight fraud committed against both the Medicaid and Medicare programs.
The goal will be to provide the broadest possible picture of the provider’s billing patterns by using significantly more Medicare data than is currently available to state investigators. For example, the Department’s time dependent billing routine will be modified to identify billings to both programs and identify providers whose billing practices may not appear suspicious if looked at in isolation. Providers who never bill for 24 hours in a day to Medicaid may frequently bill with that intensity when data from both programs are considered.
The OIG also uses information technology and data analysis to address problems that result from billing errors, as opposed to intentional fraud, and in some cases does so without the cost of sending auditors out into the field.
“This year, we identified nearly $3 million in improper billings through a self –audit program with providers,” said Maram. “We recognize the challenge legitimate medical providers face in trying to bill correctly, and we are working with them to help them identify and correct errors. It’s a win-win situation for both the Department and providers.”
Each year the IDPA Inspector General performs thousands of activities, including fraud prevention research, financial audits, quality of care reviews, Medicaid eligibility reviews, investigations of employees and contractors, welfare fraud investigations, safety monitoring of the agency’s facilities and special projects aimed at identifying and solving specific problems.
The agency works closely with the State Police and the Attorney General’s Office in investigating potentially criminal matters. Enforcement actions include: sanctions against Medicaid providers; recovery of overpayments from Medicaid providers; criminal action against Medicaid providers and public aid clients; and restriction of recipients who abuse Medicaid privileges.