Senate OKs Crowley bill to catch 
Medicaid waste and fraud

Senate OKs Crowley bill to catch 
Medicaid waste and fraud

PROVIDENCE - The Senate on Tuesday, May 7, approved legislation sponsored by Sen. Elizabeth Crowley to 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.

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

“There is technology available to stop waste and fraud before Medicaid dollars are spent on it, and we should be using it,” she said in a statement. “Every dollar we save is a dollar that can be used to help the many people who genuinely need assistance.”

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.

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. Under the Affordable Care Act, the EOHHS was recently approved for funding the system, with the federal government assuming 90 percent and the state 10 percent.

The legislation, which was sent to the House of Representatives, is co-sponsored by Sen. Donna Nesselbush, of District 15, Pawtucket and North Providence.