The Mississippi Division of Medicaid (DOM) announced this week the agency recovered $8.6 million through various audits of medical claims paid to health-care providers.
The agency said in a press release recouping funds can result from a range of factors that involve the payment or responsibilities of providers or beneficiaries, or even outright fraud, such as billing for health services a beneficiary did not receive from a provider.
The budget for Medicaid is approximately $6 billion, which is comprised of both state funds and matching federal dollars.
Most directly, DOM works closely with the Medicaid Fraud Control Unit in the office of the Attorney General.
Mississippi Attorney General Jim Hood said his agency’s partnership with DOM plays a key role in continuing the fight against fraud in healthcare benefit programs.
“The Medicaid Fraud Control Unit staff is committed to protecting our most vulnerable citizens and the resources needed to serve them,” Hood said. “Not only does our partnership allow for the prosecution of those defrauding the program and the prosecution of those abusing and neglecting patients, but it also allows court ordered restitution and penalties in both criminal and civil cases.”
During fiscal year 2017, Mississippi Division of Medicaid recorded the following activity:
• Approximately $6.3 million recovered through Third Party Liability (TPL) and Legal.
• Approximately $1.6 million recovered through Program Integrity.
• Approximately $680,000 recovered through Financial and Performance Review.
• Seven cases were referred to the Medicaid Fraud Control Unit in the attorney general’s office; DOM has identified $3.1 million as improper billing associated to those cases.
• Hundreds of cases opened for investigation.