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Anti-fraud effort achieving results

By Staff | Nov 15, 2013

Many government programs address important societal or community needs. People disagree about precisely which initiatives have merit and how much financial support they should receive. Nobody seriously disputes, however, the principle that no taxpayer money should be wasted due to fraud, abuse or avoidable errors.

Consequently, Gov. Terry Branstad’s recent announcement that an innovative and aggressive Medicaid program integrity initiative has proved highly successful is news all taxpayers should greet with applause.

According to the governor, this effort has not only achieved its original savings targets, but actually exceeded them by $18.5 over three years. In all, some $86 million has been saved so far.

“The savings are six times greater than the overall cost of the program integrity contract. … That’s very good news for taxpayers,” Branstad said in a statement released late last month. “These savings help us provide better care for 400,000 Iowans in need, without reducing provider rates or trimming services.”

The governor said this effort saved taxpayers $41 million in fiscal year 2013 alone. It is set to continue for at least two more years.

These impressive results were the outcome of a three-year, $14 million program integrity contract awarded to Optum of Eden Prairie, Minn., according to the governor’s office.

State officials say this outstanding undertaking targets fraud, abuse and errors across a variety of Medicaid programs. A major goal is to prevent abuses from occurring in the first place rather than having to undertake time-consuming and expensive recovery procedures after inappropriate payments have been made.

Most of the state’s roughly 20,000 Medicaid providers provide honest, conscientious services and bill appropriately. It is imperative, however, that those who game or otherwise defraud the system be deterred or – if need be – apprehended. It is encouraging that the state’s efforts to ensure the integrity of the Medicaid program appear to be working.

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