Morgan Medicaid Fraud Bill Gets Support In House Committee

State Representative Patricia Morgan (R-Coventry, West Warwick, Warwick) recently expressed her pleasure with the positive reception for Medicaid fraud legislation from the House Finance Committee.

Morgan’s bill (H-5748) would direct the state to utilize state-of-the-art ‘data mining’ techniques to identify fraud in several key assistance programs including Medicaid, Rite Care and RIte Share. Collectively,Rhode Island spends some $2.3 billion on these low-income assistance programs.

In a letter to the committee last week, Secretary of Health & Human Services Stephen M. Constantino registered his “strong support” for H-5748 and several other related bills strengthening efforts minimizing waste, fraud and abuse.

“It is difficult to measure Medicaid and related fraud because of the broad way fraud is defined, because fraud and Medicaid spending is growing so fast, and because there are so many unknowns," said Morgan.

“But in Rhode Island alone, we recovered some $148 million in fraudulent charges or payments in 2012, and Health & Human Services (HHS) says this is just scratching the surface," she continued.

During Wednesday’s hearing, Bruce McIntyre, HHS’s associate director of program integrity, said that one initiative would be to extend fraud investigation to managed care, which comprises care provided by hospitals. nursing homes, home-based caregivers, and the like.

Managed care accounts for some $612 million in state spending each year, while other Medicaid, RIteCare and RIShare add another $2 million.

"With $2 million in state and federal funds for data mining now available, and the clear mandate this bill provides, we can send a strong signal to those gaming the system that the games are over. The value of the involvement and support of HHS, the Attorney General and the US Attorney in this effort cannot be underestimated," Morgan said. "It is simplistic to contend, as some do, that there is little fraud in these programs. When you are spending $3 billion annually, even uncovering 5 percent is pretty significant."

“And that’s what we’re recovering now. We can do a lot better, and I am pleased my colleagues on the panel and those leading the effort at HHS are supportive of trying even harder."