On March 19th, 2012, Jack Stick, Deputy Inspector General for Enforcement for OIG, participated in a webinar hosted by the National Conference of State Legislatures. The webinar, entitled Containing Medicaid Costs: State Strategies to Fight Medicaid Fraud and Abuse, was held to share state strategies on fighting Medicaid fraud.
The webinar is still available online with slides.
However, here is a transcript of Stick’s comments in which he outlines his strategy for recovering funds. He makes such statements as:
“With that being said, about June of last year, we did a top-to-bottom review of the Office of Inspector General and we determined that at least in this division, the enforcement division, we were a little bit lopsided. We have got our division divided into both provider investigations and recipient investigations. And the overwhelming majority of the staff and financial resources were dedicated to recipient investigations. And of course that is just not really where the money is. So we make a conscious decision that we were going to revaluate our priorities and that we were going to go where the money is.”
“We have adopted an aggressive approach to credible allegations of fraud. We now will place a credible allegations of fraud hold on a payment. I’m sorry, I’m on a vendor at the intake phase. Normally, we would wait until we really gotten into a case conducted a good chunk of a full scale investigation before making a fraud determination. We stopped doing that. Moving that credible allegation of fraud determination earlier in the process has enabled us to staunch the flow of money to a bad provider and it increases the amount of our recoveries. It also gets us a lot closer to real-time fraud interdiction as opposed to the pay-and-chase method.”
“So in Texas, we have had problems with orthodontists and dentists abusing the system. So we identified the top 50 utilizers. Identified about $400 million dollars in overpayments. And conducted a series, actually, we are in the middle of conducting a series of investigations on those providers.”
“Durable medical equipment, I don’t know how it is in other states, but in Texas, if you open a DME, it almost is a sort of a neon light saying investigate me for fraud. We have 5,800 durable medical equipment providers here and our investigative approach here was just to say, look, let’s take 300 investigators and do a state-wide sweep. And let’s just see, you know, is there anybody here, is this an open field? Is it a pool or it is a legitimate ongoing business concern? The ACA requires that we visit, as you know, most of our providers and so we are going to have to go out to the DME’s anyway. So this is an initiative that will begin here in a couple of weeks. Initially it appears that we will probably we will be able to take out about 2,000 providers by doing that.”