HHS says few states have taken it up on an offer to receive federal funding for data-mining, which would allow their Medicaid fraud units to search claims. States say they don’t need it, even though the improper payment rate has nearly doubled as the number of enrollees surges.
A 2013 HHS rule allowed state Medicaid fraud control units to use federal funds for the audits, which the agencies previously had been explicitly prohibited from doing.
Only California, Indiana, Louisiana, Michigan, Missouri and Oklahoma have been granted permission to conduct the data-mining. Florida’s Medicaid fraud control unit received approval from the CMS to conduct data-mining as part of a Section 1115 waiver in 2010.
Source: HHS wants more states to data-mine for Medicaid fraud MODERN HEALTHCARE