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Medicaid Filing Services, LLC, Clearwater, FL, Comments on Medicaid Fraud Detection

June 17, 2013 - Clearwater, FL

As a company that bases its work on dealing with Medicaid, Medicaid Filing Services, LLC, Clearwater, FL, makes sure that it is following all the rules. Medicaid fraud is not a new occurrence, but one that is coming under more scrutiny. A recent article in Government Technology looks at the efforts of three states to reduce Medicaid fraud.

As the 2014 deadline for the Affordable Care Act's Medicaid expansion approaches, more people are beginning to scrutinize Medicaid fraud. There is question as to whether it will increase as the new policy takes place, and if there is anything states can do to fight back. According to the article, in 2012 federal Medicaid waste totaled $19 billion, and in 2011, state waste totaled $11 billion. Those are huge amounts. And states are making an effort to reduce these numbers by preventing or eliminating fraud.

California, Florida, and New Jersey are all states that have successfully implemented fraud prevention measures. California conducts a "Medi-Cal Payment Error Study" each year. According to Bruce Lim, deputy director of audits and investigations for the Department of Health Care Services, it is a "road map" for the state. The study looks for patterns that might suggest fraud or waste, focusing on fee-for-service providers. Results of a 2009 study "showed about $1 billion in potential overpayments, which could include administrative and other errors," according to Lim. He also said that, "Of that $1 billion, there is about $228 million in potential fraud." The program has had beneficial outcomes, making a $445 million "positive impact" in the 2011-2012 fiscal year. He believes that as technology and data improve, the effect will become even greater.

Florida uses a less technological approach. It relies on random, unannounced site visits to providers. Over a period of six months, "officials visited 244 active providers and administered 175 sanctions." This practice resulted in $90.1 million in audit recoveries and cost avoidance for the 2010-2011 fiscal year. Kelly Bennett, Florida's Medicaid fraud and abuse liaison believes the program is more beneficial because when officials visit providers, it increases compliance. This results in cost savings.

New Jersey relies on what it calls "Operation X." This program monitors individuals who have previously engaged in unethical or fraudulent practices, and tries to prevent them from collecting from Medicaid. The use a federal database to determine who has gotten money through Medicaid, and then seeks to recover the money from the person or the company they worked for. Between June 2009 and June 2011, the program collected $970,000.

According to a representative of Medicaid Filing Services, LLC, Clearwater, FL, "As the Obamacare health plan starts to be implemented in many states, fraud will also increase. The larger and more complex our health industry becomes, the harder it is to prevent fraud. I do feel that it is worth states' time and money to intently investigate fraud. There is no determining if the monies saved by hedging off fake or illegal health care companies tapping into Medicare and Medicaid. It is a huge problem now and will continue to become an even larger problem in the future if drastic measures are not taken to offset these erroneous costs." Medicaid Filing Services, LLC, Clearwater, FL, assists Florida residents to legally qualify for Medicaid coverage for long-term care.


Medicaid Filing Service, LLC, Clearwater, FL, is a company that helps Florida residents to qualify for Medicaid while preserving their assets. Their focus is on crisis Medicaid planning for those who need to qualify for coverage immediately. The company also provides free access to advanced directive forms such as those for a Power of Attorney, Living Will, or Health Care Surrogate.


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