Auditor raps state over Medicaid fraud

October 14, 2005|Associated Press

BOSTON -- The state may be losing hundreds of millions of dollars to Medicaid fraud, according to a report released yesterday by the state auditor that criticizes state officials, saying it should do more to detect and discourage spending abuses.

From 2001 to 2003, investigators recovered $17.2 million lost to theft, abuse, and fraud. That is a fraction of the $15 billion spent on MassHealth, the state's Medicaid program, auditor Joseph DeNucci said.

According to the US Government Accountability Office, an estimated 3 percent to 10 percent of all Medicaid costs nationwide are lost to fraud and abuse each year.

For Massachusetts, that translates to $450 million to $1.5 billion in potential losses for the three years covered by the report.

During the same period, out of 215 million Medicaid claims filed by providers, only 51 cases of suspected fraud and abuse were referred to the state attorney general's office for investigation. The lack of oversight is all the more dramatic given that the Medicaid program serves close to 1 million people and pays annual benefits totaling $6.3 billion.

''The resources dedicated to the detection of fraud in our Medicaid program do not match the potential scale of the program," DeNucci said in a statement.

State Health and Human Services Secretary Timothy Murphy agreed that the state could be doing more, but said estimates of hundreds of millions lost to fraud are probably high. ''We believe that when you run a program of this size, every day you are looking to improve program integrity," he said, adding that Governor Mitt Romney requested $1.5 million in his most recent budget proposal to target Medicaid waste. The money did not end up in the final budget.

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