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HARRISBURG, Pa. (AP) – A grand jury report says law enforcement and government regulators need new tools to effectively combat fraud within Pennsylvania’s $33 billion Medicaid program.
The report made public Monday by the attorney general’s office says community-based health service programs can be “easily manipulated to facilitate fraud” because they lack the supervision, training and oversight that exist in traditional residential health care facilities.
The jurors say the person who actually provides a service should be specifically named in requests for reimbursement and requests should include the time the service was provided.
They also suggest training be mandated for providers regarding care standards and proper billing practices.
The attorney general’s office says its Medicaid Fraud Control Unit made 164 arrests last year, obtained 105 convictions and recovered more than $22 million.
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