McCollum Wants More Access to Medicaid Claims
Around the State
The state attorney general is pushing the federal government to give his office improved access to Florida Medicaid claim files so it can detect fraud.
Attorney General Bill McCollum announced Wednesday that he and the state Agency for Health Care Administration (AHCA) have sent a formal waiver request to give the Attorney General’s Office authority to data-mine fee-for-service Medicaid claims files. The point is to detect fraud. This request to the secretary of the U.S. Department of Health and Human Services is the culmination of a 14-month campaign, during which McCollum has written to the federal government several times.
“We believe together that it’s likely to be granted, hopefully within the very next few weeks,” said McCollum, a Republican candidate for governor.
State fraud units are currently forbidden from launching data-mining operations for the Medicaid program‘s fraud, a state-federal partnership expected to serve 2.7 million enrollees for a total of $18.7 billion this fiscal year.
The waivers would make the Attorney General’s Office the first agency in the nation not directly related to Medicaid to have access to Medicaid files. The AHCA administers Medicaid in the state,
The improved access to Medicaid files would allow McCollum’s Medicaid Fraud Control Unit, in what McCollum is referring to as a pilot project, to investigate specific incidents like inflated bills from practitioners’ offices.
Tom Arnold, the secretary of the AHCA, said the agency receives more than 1 million claims a day and has 100 staff members who investigate for fraud. The attorney general’s staff would add to that investigative force.
“We think the improvement by allowing the attorney general’s Medicaid Fraud Control Unit in the office is a key to finding that fraud and abuse that has thus far eluded us,” Arnold told reporters. “There’s always a question of how much there is in terms of fraud and abuse, and the more eyes we can have looking at the claims history, the better it will be."
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