Medicaid Maintenance-of-Effort Requirement Does Not Stop States from Fighting Fraud
End Notes
[1] Judith Solomon, “Repealing Health Reform’s Maintenance of Effort Provision Could Cause Millions of Children, Parents, Seniors, and People With Disabilities to Lose Coverage,” Center on Budget and Policy Priorities, February 24, 2011.
[2] U.S. Department of Health and Human Services and U.S. Department of Justice, “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2011,” February 2012. Some of the transfers reported in fiscal year 2010 are the result of judgments, settlements and actions that occurred in prior years, and some actions in 2010 will result in future transfers.
[3] William Corr, Department of Health and Human Services, Testimony before the House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, March 4, 2010.
[4] “Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion,” HHS and DOJ news release, February 14, 2012.
[5] Center for Program Integrity, Centers for Medicare and Medicaid Services, “Annual Report to Congress on the Medicaid Integrity Program for Fiscal Year 2010,” 2011.
[6] U.S. Department of Health and Human Services, “New Tools to Fight Fraud, Strengthen Medicare, and Protect Taxpayer Dollars,” March 15, 2011.
[7] Louis Saccoccio, Testimony before the House Committee on Ways and Means, Subcommittee on Oversight, National Health Care Anti-Fraud Association, March 2, 2011.
[8] “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2010,” op cit.
[9] Sara Rosenbaum, Testimony before the House Committee on Energy and Commerce Subcommittee on Oversight and Investigation, March 2, 2011. See also, National Health Care Anti-Fraud Association, “The Problem of Health Care Fraud,” accessed at www.nhcaa.org on May 20, 2011.
[10] See for example, “Medicaid Payment Error Rate Measurement Final Report, Fiscal Year 2008,” Department of Health and Human Services, October 21, 2009, pp. 27-28.
[11] PERM error rates include both underpayments and overpayments, people being placed in the incorrect program, and (as noted previously) documentation problems even if no improper payment was made. The main purpose of state error rates is to calculate a national error rate, and state rates may not be meaningful on their own.
[12] Only one other state, Tennessee, has retained any face-to-face interview requirement for children, and this is only for Medicaid enrollment (not for renewal, and not for CHIP). See “Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost Sharing Practices in Medicaid and CHIP, 2010-2011,” Georgetown Center for Women and Families and the Kaiser Family Foundation, January 2011.
[13] “Losing Ground: Declines in Health Coverage for Children and Families in Mississippi,” the Mississippi Center for Justice and the Mississippi Health Advocacy Program, Fall 2007.
[14] Christopher Rowland, “Amid strained clinics, foe assails ‘Obamacare,’” The Boston Globe, April 20, 2011.
[15] “Losing Ground,” op cit. See also, Sarah Lueck, “Mississippi’s ‘Face-To-Face’ Rule Blocks Coverage of Eligible People, Not Fraud,” Center on Budget and Policy Priorities, March 25, 2009.
[16] Washington State Department of Social and Health Services, 2006.