Crowley highlights proposal to catch Medicaid waste and fraud

Crowley highlights proposal to catch Medicaid waste and fraud

PROVIDENCE - Sen. Elizabeth Crowley is sponsoring legislation that would require the state to use technology to screen Medicaid, RIte Care and RIte Share claims to prevent them from being paid to unlicensed, sanctioned or deceased providers and to detect other forms of potential Medicaid fraud.

The legislation has the support of Health and Human Services Secretary Steven Costantino, whose agency is already soliciting proposals for such a system. The Office of Health and Human Services is also in the process of creating a new Program Integrity Unit to root out waste and fraud within Rhode Island’s health and human service programs.

Crowley, a Democrat serving District 16 in Central Falls and Pawtucket, said that technology is an effective means of detecting improper claims because it can be used to block individuals, such as retired, deceased or sanctioned providers, whose names might be used to make fraudulent claims. It can also detect unusual or suspicious patterns in claims that could indicate fraud.

“This technology is available, and using it could save millions in state and federal money," she said in a statement. "That’s money that is currently going to the wrong people and could be used instead to help Rhode Islanders and improve services."

The legislation seeks to stop suspicious claims before they are paid, since the current “pay and chase” model means that many who commit fraud frequently dissolve their businesses and change the names and addresses they use to make claims to stay ahead of investigators, according to Crowley.

Medicaid, and the RIte Care and RIte Share programs that use Medicaid funding to help provide care to needy families, are paid for jointly by the federal government and the state.

Although her legislation was filed in February, Crowley said she believes the report released last week on waste in the state’s assistance programs by software engineer and former gubernatorial candidate Ken Block illustrates the need for a more effective system of preventing misuse of the funds.

“If that report is correct, in dental expenses alone, we may be spending $4.5 million more than we should. That’s a lot of money that could be put to better use. If we weren’t spending so much there, maybe we could afford to offer health care to more Rhode Islanders,” said Crowley. “That’s really my point; I understand how many people in our state, and in my own district, are unable to afford health care. I want us to use the money we have in the most effective ways to do the most good.”

Crowley's legislation had a hearing March 14 before the Senate Health and Human Services Committee, which held it for further study. One of its co-sponsors is Sen. Donna Nesselbush, a Democrat serving District 15 in Pawtucket and North Providence.