President Obama released his proposed budget for FY 2012 on February 14. The Medicaid and program integrity sections of the proposed budget would reduce the states’ ability to impose provider taxes to generate the state share of Medicaid expenditures, tighten certification of public expenditure (CPE) requirements to ensure that federal funds are not used to satisfy state Medicaid matching obligations, widen states’ options to deny Medicaid claims if other payers may be legally responsible for the claims, limit Medicaid payments for durable medical equipment (DME) to Medicare rates obtained through Medicare’s DME competitive bidding program, and increase state Medicaid tracking of high prescribers and high users of prescription drugs. The proposed reductions in state use of provider taxes to finance Medicaid require Congressional approval and would be phased in gradually. The President also proposes more auditing of manufacturers’ compliance with Medicaid drug rebate agreements, more severe penalties for manufacturers’ noncompliance, and more stringent requirements that manufacturers repay states for manufacturers’ rebate underpayments. The budget proposal would expand federal authority to exclude individuals from participating in the Medicaid program if affiliated with an entity sanctioned for Medicaid program abuse, increase penalties for improper distribution of Medicaid recipient data that can be used to generate false claims, and target the use of predictive analytics technology to achieve the highest return on investment in detecting Medicaid fraud. The budget projects that 57 million persons (including 29 million children) will receive health coverage through Medicaid in 2012 at a cost of $269 billion in federal expenditures.
About Tom Entrikin
A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.
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