Today a House Oversight subcommittee looks into the effectiveness of fraud prevention efforts within Medicaid. They heard from a Medicaid recipient denied coverage after his provider billed for services he never received.
That witness, Richard West, was denied Medicaid coverage for going over his limits, but knew he hadn’t because he recorded all his services. He found out his provider, Maxim, was billing the Centers for Medicare & Medicaid Services (CMS) for services he wasn’t receiving.
According to Mr. West when he told CMS they didn't take appropriate action and he then filed a whistleblower lawsuit. When CMS investigated, they found that Maxim had improperly billed for over $150 million in improper claims.
In the second panel, witnesses from the Medicaid program discuss fraud prevention and detection efforts and defend their record to subcommittee members.