HHS recently announced deferring more than $1 billion in Medicaid payments to California and Minnesota, pending receipt and review of documentation these states have been required to submit, to address allegations of fraud in certain Medicaid claims.
While AHCA/NCAL supports CMS’ stated goal to combat fraud, waste, and abuse, effective program integrity depends not only on strong enforcement authorities, but also on targeted, risk-based policies that distinguish intentional misconduct from inadvertent administrative errors. This unprecedented use of the compliance process to withhold such a substantial amount of funding from providers risks creating significant access and quality of care issues for the vulnerable Americans Medicaid is meant to serve.
Additionally, while CMS states that deferring these payments is intended to target only certain high-risk services within the Medicaid program, withholding such substantial funds from these programs utilizing a method that lies outside of the standard disallowance process undoubtedly has trickle-down effects that could compromise the health and safety of Medicaid beneficiaries outside of these high-risk areas.
We hope to continue to work with HHS to combat fraud, waste, and abuse within the Medicaid program in a manner consistent with ensuring that beneficiary access to high-quality care is maintained and that vulnerable populations are not threatened due to the actions of a few bad actors.