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NCJ Number: 67031 Add to Shopping cart Find in a Library
Title: PENNSYLVANIA NEEDS AN AUTOMATED SYSTEM TO DETECT MEDICAID FRAUD AND ABUSE
Author(s): ANON
Corporate Author: US Comptroller General
United States of America
Date Published: 1979
Page Count: 27
Sponsoring Agency: Azimuth Inc.
Fairmont, WV 26554
US Comptroller General
Washington, DC 20548
Sale Source: Azimuth Inc.
1000 Technology Drive, Suite 3120
Fairmont, WV 26554
United States of America
Type: Program/Project Evaluation
Language: English
Country: United States of America
Annotation: FINDINGS AND RECOMMENDATIONS ARE REPORTED FROM A GENERAL ACCOUNTING OFFICE EVALUATION OF PENNSYLVANIA'S METHODS FOR CONTROLLING AND DETECTING MEDICAID FRAUD AND ABUSE.
Abstract: MEDICAID FRAUD AND ABUSE CAN GO UNDETECTED IN PENNSYLVANIA, PRIMARILY BECAUSE THE STATE DOES NOT HAVE AN AUTOMATED CLAIMS PROCESSING AND INFORMATION RETRIEVAL SYSTEM IN FULL OPERATION. MORE STATE FUNDS ARE NEEDED TO IMPLEMENT THE PLANNED MEDICAID MANAGEMENT INFORMATION SYSTEM (MMIS). IN ADDITION TO PROVIDING THE STATE WITH AN EFFECTIVE CLAIMS PROCESSING SYSTEM, MMIS CAN ANALYZE THE CLAIMS DATA BASE TO IDENTIFY POTENTIAL FRAUD AND ABUSE. FEDERAL AND STATE INVESTIGATIONS OF MEDICAID FRAUD HAVE INCREASED DURING THE PAST YEAR, BUT HAVE LED TO FEW PROSECUTIONS. THE PENNSYLVANIA MEDICAID FRAUD CONTROL UNIT ONLY RECENTLY TOOK STEPS TO COMPLY WITH A FEDERAL REQUIREMENT TO ASSURE REFERRAL OF CASES FOR PROSECUTION. THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE SHOULD REVIEW THE UNIT'S ACTION. PENNSYLVANIA RELIES ON CRIMINAL STATUTES ON WHICH TO BASE ITS PROSECUTION OF FRAUD CASES, SOME OF WHICH CALL FOR LESSER PENALTIES THAN DO THE FEDERAL MEDICAID FRAUD STATUTES. TO COMBAT MEDICAID FRAUD, PENNSYLVANIA SHOULD ESTABLISH PROVIDER AND RECIPIENT FRAUD STATUTES CONSISTENT WITH FEDERAL STATUTES. (AUTHOR ABSTRACT MODIFIED--RCB)
Index Term(s): Crime detection; Crime specific countermeasures; Management Information Systems; Medicaid/Medicare fraud; Medical fraud; Pennsylvania; Program evaluation; US Government Accountability Office (GAO)
Note: THERE IS A CHARGE FOR MORE THAN ONE COPY.
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http://www.ncjrs.gov/App/publications/abstract.aspx?ID=67031

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