The State of Iowa has paid a private company $14 million to review Medicaid claims — and over the past three years this so-called “integrity effort” has netted over $86 million in savings. Lieutenant Governor Kim Reynolds says most of the savings came from catching errors and fraud in advance.
“After all, it is absolutely less costly to stop inappropriate claims than to chase them down and recover the funds,” Reynolds says. “For providers who make mistakes or are simply misinformed there’s an education component to help them get back on track.”
Cases of suspected Medicaid fraud are being turned over to investigators in the Iowa Department of Inspections and Appeals.
“We’re using sophisticated techniques to stop their efforts and our tactics are working,” Reynolds says. “Some savings came from cracking down on in-home respite care providers who were billing for services not provided, claiming they were at two homes at the same time, and/or they were inflating the time that they were spending in each one of the homes.”
In addition, the private company reviewing Iowa Medicaid claims has pushed for the purchase of medical equipment rather than long-term rental agreements which turn out to be more costly than buying the equipment in the first place.
“The majority of the Medicaid providers are honest and doing a good job,” says Jennifer Vermeer, director of the Iowa Medicaid Enterprise. “This is a relatively small number of providers, but this small number of providers can cost millions of dollars, so it’s important to follow-up.”
Optum — the private company reviewing Iowa Medicaid billing — is based in Minnesota. State officials say there are about 20,000 Medicaid providers in Iowa.