WASHINGTON, D.C. – In a proactive move to address fraud at the state level, AAHomecare is coordinating with state associations to send letters to state Medicaid directors, along with the AAHomecare’s comments on CMS’ CRUSH RFI. The joint letter (sample found here) underscores the industry’s full support for ridding Medicaid programs of fraud, waste and abuse and offers to work with program directors to ensure bad actors cannot defraud the program.
As the letter states: “We recognize that fraud not only drains critical resources but also creates an unfair ‘black eye’ for the many legitimate, law-abiding suppliers who serve the most vulnerable patient populations.”
AAHomecare’s outlined recommendations include a unified “red flag” system to improve cross-program enforcement, ensuring that a revocation based on fraudulent activity is final and comprehensive, effectively barring bad actors from the entire government healthcare landscape.
The letter outlines these suggestions as well as outlines a risk-based audit framework to better target improper activity, stating: “Establishing a ‘gold standard’ pathway for consistently high-performing providers would reduce unnecessary audit frequency and allow program integrity resources to be more effectively targeted toward higher-risk entities.”
The letter further recommends that state Medicaid programs leverage artificial intelligence and predictive analytics to flag irregular claims before payment, enabling payers to proactively identify suspicious activity and prevent improper payments.
The letter concludes by offering to partner with the state on these efforts, noting that by working together, the associations and state programs can keep bad actors out of Medicaid while continuing to support the many legitimate suppliers who care for patients in their homes.