Medicaid Audit Cost Five Times More Than It Recovered

Over the past five years, a federal program to fight Medicaid fraud has cost the U.S. at least $102 million in auditing fees while identifying less than $20 million in overpayments, Government Accountability Office investigators have found.  The majority of the audits conducted by the National Medicaid Audit Program’s Medicaid Integrity Group were discontinued, produced low or no findings, or were put on hold. More than 2/3 of 1,550 audits of state records since fiscal year 2008 identified $7.4 million in possible Medicaid overpayments.   

Audits of state Medicaid records were stopped in February 2011. The federal Centers for Medicare and Medicaid Services has reportedly reassigned the auditors to work collaboratively with states’ own audit activities.  This arrangement requires state Medicaid officials to identify health providers or industries they think federal auditors should target.  There are reportedly 137 collaborative audits underway.