Testimony Before the United States Senate Committee on Homeland Security 
and Governmental Affairs 
 
 
 
 
Medicaid Fraud and Overpayments: Problems and Solutions 
   
Testimony of: 
 
Brian P. Ritchie 
Assistant Inspector General for Audit Services 
Office of Inspector General 
U.S. Department of Health and Human Services 
 
 
 
 
 
 
 
 
June 27, 2018 
10:00 a.m. 
Dirksen Senate Office Building, Room 342 
 
    Testimony of: Brian P. Ritchie 
Assistant Inspector General for Audit Services 
U.S. Department of Health and Human Services, Office of Inspector General 
 
Good morning, Chairman Johnson, Ranking Member McCaskill, and distinguished Members of 
the committee.  I am Brian P. Ritchie, Assistant Inspector General for Audit Services, U.S. 
Department of Health and Human Services.  Thank you for your longstanding commitment to 
ensuring that the Medicaid programs 67 million beneficiaries are well served and the 
taxpayers approximately $600 billion investment is well spent.  I appreciate the opportunity to 
discuss the Office of Inspector Generals work to combat fraud, waste, and abuse in Medicaid 
and what more can be done to secure the future of this important program.    
 
Introduction 
 
Medicaid spending represents onesixth of the national health care economy, and Medicaid 
serves more people, including some of the Nations most vulnerable individuals, than any 
other Federal health care program.  Congress created the Office of Inspector General (OIG) 
for the U.S. Department of Health and Human Services (HHS or the Department) in 1976 as 
an independent body to oversee HHS programs.  A key component of my offices mission is to 
promote integrity and efficiency in Medicaid and other Federal health care programs.  While 
OIG does not directly operate the Medicaid program, through a nationwide program of 
audits, evaluations, inspections, investigations, and enforcement actions, OIG has identified 
numerous vulnerabilities to program operations and offered specific recommendations to the 
Centers for Medicare & Medicaid Services (CMS) and its State partners for how to mitigate or 
eliminate those vulnerabilities and enhance the economy and efficiency of the Medicaid 
program going forward. 
 
OIG shares the committees commitment to protecting Medicaid from fraud, waste, and abuse 
and has an extensive body of oversight work in this area.  Persistent challenges include high 
improper payment rates, inadequate program integrity safeguards, and beneficiary health and 
safety concerns.  In our extensive experience combating various types of vulnerabilities in all 
regions of the country, across all provider types, regarding all classes of items and services, one 
program administration shortcoming has emerged as a consistent impediment to effective 
oversight.  That shortcoming is the lack of a robust national Medicaid dataset that is complete, 
accurate, and timely.  A complete, accurate, and timely Medicaid dataset would greatly 
facilitate Medicaid program operations and promote economy and efficiency. 
 
Much program integrity work seeks to recover improper payments already made and reduce 
improper payments going forward.  In FY 2017, projected improper Medicaid payments 
totaled about $59 billion.  CMS must do more to ensure that Medicaid payments are made to 
the right provider, for the right amount, for the right service, on behalf of the right 
beneficiary.   
 
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June 27, 2018   
My testimony addresses how to protect Medicaid and its program beneficiaries through the 
lens of OIGs core program integrity principles of prevention, detection, and enforcement.  
Enhanced data functionality offers crosscutting benefits that would enhance prevention, 
detection, and enforcement to correct problems and prevent future harm. 
 
Oversight of CMSs Efforts To Address Fraud and Overpayments in Medicaid 
 
Complete and reliable national Medicaid data are necessary for effective program oversight 
and management and to detect bad actors.  
 
The ability to detect problems in real time, or as close to real time as possible, enables effective 
oversight and can protect patients and help prevent improper payments.  CMS, States, 
Medicaid managed care entities, and providers share the responsibility for detecting and 
addressing problems in the Medicaid program.  The lack of national Medicaid data hampers the 
ability to quickly detect and address improper payments, fraud, waste, or quality concerns, 
both within States and across the Nation.  
 
CMS must ensure the completeness and reliability of data in the Transformed Medicaid 
Statistical Information System. 
 
Congress has recognized the value of enhanced Medicaid data, but more needs to be done to 
achieve the goal.  Through the Balanced Budget Act of 1997, Congress mandated that States 
submit data to provide for a national Medicaid dataset.  The Transformed Medicaid Statistical 
Information System (TMSIS) is a joint effort by CMS and the States to address previously 
identified problems with national Medicaid claims and eligibility data.  CMSs goals for TMSIS 
are to improve the completeness, accuracy, and timeliness of Medicaid data.   
 
CMS began testing TMSIS with 12 volunteer States in 2011.  TMSIS builds on and replaces the 
Medicaid Statistical Information System.  CMS initially set a goal for all States to submit TMSIS 
data by July 2014.  CMS subsequently extended that deadline several times.  After multiple 
missed implementation deadlines, technological problems, competing priorities, and other 
implementation delays, as of May 2018, 49 States (all States except Wisconsin) and the District 
of Columbia had begun reporting data to TMSIS, but concerns remain about the quality and 
completeness of the data reported.  
 
OIG is concerned about whether the data will be actionable, as our work has identified 
numerous issues with the completeness and quality of the data.  We found that States are not 
consistently submitting the same TMSIS data elements, limiting the ability to make 
comparisons across all States.  Despite CMSs attempts to further standardize meaning through 
a revised standard data dictionary, TMSIS data elements may not mean the same thing across 
States.  Different interpretations across States could result in data that is not comparable across 
different States.   
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Until CMS and States achieve full implementation, the Department must prioritize obtaining 
complete and reliable TMSIS data.  CMS must ensure that the same data elements are 
consistently reported and uniformly interpreted across States to best inform program 
management and oversight.  To accomplish this, OIG recommends that CMS establish a 
deadline for when national TMSIS data will be available for multiState program integrity 
efforts.  Without the prioritization motivated by a fixed deadline, some States and CMS may 
delay full implementation of TMSIS to the detriment of Medicaid program integrity.   
 
CMS should ensure that States report encounter data for all managed care entities. 
 
Eighty percent of all Medicaid beneficiaries receive part or all of their services through 
managed care.  For CMS and States to operate Medicaid effectively at both the Federal and 
State level, it is vital that TMSIS include complete and accurate managed care encounter data.  
State Medicaid agencies contract with managed care entities to deliver health care services and 
perform certain administrative functions such as data collection and reporting.  Most 
importantly, managed care entities are required to report medical claims data, known as 
encounter data, to States that then report the data to CMS via TMSIS.  Encounter data include 
detailed information about the services provided to Medicaid beneficiaries enrolled in managed 
care.  Like feeforservice Medicaid claims, encounter data are the primary record of services 
provided to Medicaid beneficiaries enrolled in managed care.  The Society of Actuaries calls 
encounter data the single most important analytical tool for health plans and health programs.  
Without accurate and timely data, it is not possible to analyze costs, utilization or trends; 
evaluate benefits; or determine the quality of services being provided.   
 
OIG found that States Medicaid managed care encounter data were incomplete.  Reasons that 
States cited for their failure to report complete information included the inability to collect 
encounter data from some managed care entities and limitations in the States data systems.  
CMS has made some progress in addressing this problem, including regulatory requirements, 
guidance, and an ongoing data quality monitoring review of submissions of encounter data 
through TMSIS.  However, the Department must do more to ensure that the data necessary to 
support program integrity in Medicaid managed care are complete, accurate, and timely.  Thus, 
OIG continues to recommend that CMS ensure that States report encounter data for all 
managed care entities. 
 
The lack of quality national Medicaid data hampers enforcement efforts. 
 
States and the Federal Government need a highquality Medicaid dataset to effectively 
administer the Medicaid program.  National data can be used to identify fraud schemes and 
other vulnerabilities that cross State lines.  Even localized schemes are more easily concealed 
absent national data.  Aberrant utilization or spending patterns may not appear problematic 
until compared against another States experience or national averages.  Identifying such 
schemes in one State can alert other States to patterns of fraudulent or abusive practices that 
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Senate Committee on Homeland Security and Governmental Affairs 
June 27, 2018  may be occurring in their jurisdiction.  This information can generate referrals to State law 
enforcement agencies like the State Medicaid Fraud Control Units or joint investigations across 
State lines.  Complete and reliable data are critical to identifying improper payments and to 
enable Federal and State enforcement efforts to keep fraudulent and harmful providers out of 
Medicaid and hold bad actors accountable.  National Medicaid data holds the promise of 
supporting and amplifying enforcement efforts.  We have seen this potential for data to 
strengthen the effectiveness of enforcement efforts.  For example, in July 2017, OIG and its law 
enforcement partners conducted the largest ever National Health Care Fraud Takedown.  
Sophisticated data analytics played an indispensable role in enabling the success of this 
takedown.  The end resultcharges against more than 400 defendants across 41 Federal 
districts for their alleged participation in health care fraud schemes involving about $1.3 billion 
in false billingsprotected the programs and sent a strong signal that theft of taxpayer funds 
will not be tolerated.  Notably, 120 defendants, including doctors, were charged for illegally 
prescribing and distributing opioids and other dangerous drugs, and 295 providers were served 
with exclusion notices for conduct related to opioid diversion and abuse.  A concurrent data 
brief underscored the magnitude of the opioid problem, identifying concerns about extreme 
use and questionable prescribing of opioids in Medicare Part D.  That is the potential of data 
leveraged by skilled auditors, investigators, and analyststo protect the program, to protect 
beneficiaries, and to bring bad actors to justice.   
 
Unfortunately, we currently cannot replicate this type of analysis in Medicaid.  Development of 
a national Medicaid dataset would promote economy and efficiency in Medicaid by facilitating 
timely detection of and rapid response to improper payments and fraud.  Quality national 
Medicaid data provide visibility into payments and offer the transparency necessary to 
determine whether Medicaid is paying the right amount, to the right provider, for the right 
service, on behalf of the right beneficiary.  OIG can harness the power of accurate, timely, and 
complete data not only to support enforcement efforts, but also to identify vulnerabilities to 
avoid, and best practices to replicate with the ultimate goal of promoting value and improving 
quality of care.  While CMS and States have made important strides to improve Medicaid data, 
more can be done to ensure TMSIS achieves its full potential.  Ultimately, TMSIS will be only 
as useful as the data it receives.  This is why CMS must ensure the completeness and reliability 
of TMSIS data and improve provider enrollment data to prevent unscrupulous providers from 
enrolling in Medicaid and gaining access to Medicaid funds and beneficiaries.  Such data are 
essential to the efficiency, effectiveness, and integrity of Medicaid.  Savings achieved through 
improved program integrity and reduced improper payments could fund improved services for 
beneficiaries. 
 
Leveraging Tools To Prevent Fraud   
 
Although OIG has extensive experience conducting investigations and enforcement actions to 
recoup improper payments and exclude fraudulent providers, the first pillar of our program 
integrity strategy is prevention.  Keeping bad actors and ineligible beneficiaries out of the 
program on the front end prevents improper payments.  Complete and reliable data can help 
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Senate Committee on Homeland Security and Governmental Affairs 
June 27, 2018  States achieve this frontend integrity.  By knowing with whom they are doing business, States 
can enroll trusted providers and avoid paying, or having their beneficiaries endure subpar 
services from, providers who do not deserve such trust.   
 
States have not fully enacted enhanced provider screening.   
 
To ensure that Medicaid pays the right provider, the program must be able to identify the 
providers with whom it does business, and keep bad actors out of the program.  Preventing bad 
actors from entering the Medicaid program not only reduces improper payments, but also 
protects patients from harm.   
 
States must screen providers commensurate with the potential risk for fraud, waste, and abuse 
that they pose to Medicaid, with highrisk providers requiring more intense scrutiny.  However, 
States often fail to effectively screen highrisk providers, including key safeguards like 
conducting fingerprintbased criminal background checks and site visits.  Previous OIG work 
found that many States had yet to implement fingerprintbased criminal background checks 
and site visits.  OIG made recommendations to CMS to assist States with implementing these 
activities.  CMS concurred with OIGs recommendations and has provided assistance to States.  
However, CMS has extended the deadline for implementation of fingerprintbased criminal 
background checks, indicating that States have not yet resolved the vulnerability inadequate 
background check procedures pose for provider enrollment.  OIG has ongoing work to provide a 
status update on implementation of fingerprintbased criminal background checks. 
 
CMS must ensure that States timely and fully implement these critical safeguards lest bad 
actors defraud Medicaid of millions of dollars and endanger beneficiaries.  For example, in 
Virginia two individuals conspired to defraud a special caregiver program covered under 
Medicaid by submitting timesheets for payment for services that were never rendered.  One of 
the conspirators was actually incarcerated on the days when he falsely claimed to have 
provided Medicaid services.  Better compliance with criminal background check requirements 
can help prevent similar fraud schemes. 
 
In another example, in North Carolina a mental health facility operator submitted fraudulent 
Medicaid claims for services for beneficiaries with developmental disabilities.  The operator 
submitted at least $2.5 million in fraudulent claims using stolen beneficiary information from a 
defunct company that he previously coowned, and he received more than $2 million in 
reimbursements from Medicaid.  State site visits could have revealed that the beneficiaries 
never actually received services.  
 
These cases exemplify why OIG recommends that CMS improve provider screening by working 
with States to implement fingerprintbased criminal background checks and site visits for high
risk providers.   
 
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Senate Committee on Homeland Security and Governmental Affairs 
June 27, 2018  For provider screening to be truly effective, States need timely, complete, and accurate data to 
identify the providers seeking access to Medicaid monies and patients.  OIG has issued several 
recommendations to reduce duplicate provider enrollment data collection by sharing data 
across States or creating central repositories.  Sharing data across States and with Medicare 
data systems would streamline the Medicaid enrollment process and reduce the chance for 
error within any one database.  A joint enrollment system would provide a onestop shop for 
State Medicaid officials and providersreducing provider burden and duplication in reporting, 
verifying, and updating information.  This could reduce datacollection duplication and burdens 
on States and providers and improve the completeness and accuracy of the data available to 
Medicaid.  The Presidents FY 2019 Budget request includes a proposal to consolidate provider 
enrollment screening for Medicare, Medicaid, and the Childrens Health Insurance Program. 
 
Reducing Improper and Wasteful Payments and Ensuring Compliance With Fiscal Controls  
 
Ensuring Compliance with Fiscal Controls 
 
Reducing improper payments to providers is a critical element in protecting the financial 
integrity of Medicaid.  In FY 2017, HHS reported a Medicaid improper payment rate of 10.1 
percent.  CMS has engaged with State Medicaid agencies to develop corrective action plans 
that address Statespecific reasons for improper payments as a part of CMSs Payment Error 
Rate Measurement program, which measures Medicaid improper payments.  CMS has 
facilitated national best practices calls to share ideas across States, provided State education 
through the Medicaid Integrity Institute, offered ongoing technical assistance, and provided 
additional guidance as needed to address the root causes of improper payments.  CMS has 
indicated that it continues to provide guidance to States on their procedures for calculating and 
claiming costs under waiver programs for home and communitybased services. 
 
OIG audits have identified substantial improper payments to providers across a variety of 
Medicaid services, including schoolbased services, nonemergency medical transportation, 
targeted case management services, and personal care services.  OIG has also identified several 
States that made improper payments to Medicaid managed care entities.  More specifically, we 
found that several States made monthly capitated payments on behalf of deceased Medicaid 
beneficiaries, and we identified several States that made duplicate monthly capitated payments 
for the same beneficiary.  CMS should continue to engage with State Medicaid agencies to 
develop corrective action plans and provide specific guidance to States regarding services and 
benefits most vulnerable to improper payments. 
 
OIG audits have identified billions of dollars in Medicaid overpayments that States should pay 
back.  OIG has conducted extensive work looking at how much of this money CMS has 
collected.  One OIG study found that CMS had collected about 80 percent of $1.2 billion in 
Medicaid overpayments identified in certain audits.  OIG plans continued work in this area to 
ensure the program effectively reclaims overpayments.  
 
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Senate Committee on Homeland Security and Governmental Affairs 
June 27, 2018  At times, States may exploit the FederalState partnership for Medicaid financing to improperly 
shift costs to the Federal Government.  OIG has identified a number of State policies that may 
inflate the Federal share of Medicaid expenditures.  States have misused provider taxes, 
intergovernmental transfers, supplemental payments, and inflated payment rates to increase 
the Federal Medicaid funding that States receive.  Such practices may distort the statutorily 
defined Federal share of Medicaid expenditures and undermine the FederalState partnership. 
 
CMS has tried to curtail inappropriate State financing mechanisms that inflate the Federal share 
of Medicaid costs.  For example, CMS issued guidance to State Medicaid directors and State 
health officials to clarify the rules for health care provider taxes. 
 
But more needs to be done.  CMS should closely review State Medicaid plans and plan 
amendments to identify any potentially inappropriate costshifting from States to the Federal 
Government. 
 
Oversight of Eligibility Determinations  
 
States are not always correctly determining Medicaid eligibility for beneficiaries. 
   
Correctly determining beneficiary eligibility is vital to the accuracy of Medicaid payments.  To 
ensure that Medicaid makes payments on behalf of the right beneficiary, it is critical to 
determine whether the beneficiary receiving services is actually eligible for Medicaid.  Recent 
OIG audits of three States estimated that more than $1.2 billion in Federal Medicaid payments 
has been made on behalf of potentially ineligible and ineligible beneficiaries.  Lack of 
enrollment data systems functionality was a key contributor to these payments. 
OIG recently reviewed whether certain States were correctly determining eligibility, following 
changes made by the Affordable Care Act (ACA) to Medicaid eligibility rules.  ACA allowed 
States to expand Medicaid eligibility for certain lowincome adults and claim a higher Federal 
Medical Assistance Percentage for those who are newly eligible under the expansion.  As a 
result of States incorrectly determining beneficiaries eligibility, payments made on behalf of 
those beneficiaries could be incorrect, resulting in the improper shift of costs from the State to 
the Federal Government.  OIG reviews of Medicaid eligibility determinations by California, New 
York, and Kentucky reveal that these States did not always comply with Federal and State 
requirements to verify applicants income, citizenship, identity, and other eligibility criteria.  In 
total, across these three States, OIG estimated that more than $580 million in Federal Medicaid 
payments were made on behalf of 183,579 potentially ineligible beneficiaries, and about $655 
million in payments made on behalf of 413,349 ineligible beneficiariesover $1.2 billion in 
total for more than 596,000 beneficiaries.  Both human and system errors contributed to these 
payments, with some enrollment data systems lacking the ability to (1) deny or terminate 
ineligible beneficiaries; (2) properly redetermine eligibility when a beneficiary aged out of an 
eligibility group; (3) maintain records, per Federal requirements, relating to eligibility 
determinations and verifications; and (4) retrieve and use information from other Government 
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Senate Committee on Homeland Security and Governmental Affairs 
June 27, 2018  databases, such as those managed by the Social Security Administration and Department of 
Homeland Security.    
To ensure compliance with Federal and State requirements for determining Medicaid eligibility, 
we recommended that States ensure that enrollment data systems are able to verify eligibility 
criteria, develop and implement written policies and procedures to address vulnerabilities, and 
undertake redeterminations as appropriate.   
 
Medicaid is overpaying for prescription drugs due to underpaid rebates 
 
To help contain the costs of prescription drugs in Medicaid, manufacturers are generally 
required to pay rebates to the States for covered outpatient drugs under the Medicaid Drug 
Rebate Program.  As part of the rebate agreements, manufacturers must report product and 
pricing information to CMS that is used to calculate the rebates owed.  CMS and States share 
responsibility for ensuring that manufacturers pay all rebates to which the States and Federal 
Government are entitled.   
 
Ensuring that manufacturers report product and pricing information correctly is a challenge for 
HHS.  Manufacturer misreporting can result in manufacturers underpaying rebates, which 
inappropriately increases Federal and State Medicaid costs.  We found that from 2012 to 2016, 
Medicaid may have lost $1.3 billion in base and inflationadjusted rebates for 10 potentially 
misclassified drugs.   
 
Overseeing States collection of manufacturer rebates is also a challenge for HHS.  OIG has 
identified instances in which States failed to bill for or collect Medicaid rebates for physician
administered drugs, forgoing money owed to those States and the Federal Government.  OIG 
has ongoing work assessing CMSs oversight of the Medicaid Drug Rebate Program to identify 
opportunities for improvement.   
 
Quality of Care  
 
Medicaid must know with whom it is doing business, not only to prevent improper payments to 
ineligible providers, but also to protect beneficiaries from lowquality care.  OIG has raised 
concerns about the varying standards, and in some cases, minimal vetting, for Medicaid 
personal care services (PCS) providers, potentially exposing the Medicaid program to financial 
fraud and Medicaid beneficiaries to abuse and neglect.  For example, an elderly woman in 
Idaho was found dangerously malnourished and dehydrated after her Medicaidfunded 
caregiver failed to provide her with water and food.  Investigators found the woman living in 
filth, when Medicaid was paying a PCS attendant to care for her everyday needs.  OIG continues 
to recommend that CMS improve States ability to monitor billing and care quality by requiring 
States to either enroll PCS attendants as providers, or require them to register with their State 
Medicaid agencies, and assign each attendant a unique identifier. 
 
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Senate Committee on Homeland Security and Governmental Affairs 
June 27, 2018  Group Homes  
 
In response to reports of abuse and neglect of developmentally disabled residents in group 
homes, OIG launched a series of audits examining how States responded to critical incidents in 
group homes.  OIG found that up to 99 percent of these critical incidents were not reported to 
the appropriate law enforcement or State agencies as required.  To address these troubling 
findings, we worked with experts from HHS Administration for Community Living, HHS Office 
for Civil Rights, CMS, the Department of Justice, and State stakeholders to create a joint report 
entitled Ensuring Beneficiary Health and Safety in Group Homes Through State Implementation 
of Comprehensive Compliance Oversight.  This report contains workable, holistic solutions that 
States can use to protect the health and safety of their residents living in group 
homes.  Building on State efforts to protect people with disabilities in group homes, the report 
features suggested Model Practices for States and offers suggestions on the Federal level for 
CMS.  These Model Practices focus on four main aspects of handling critical incidents: 
investigation, reporting, correction, and transparency and accountability.  The joint report 
contains detailed suggestions, including what actions States should take when group homes 
repeatedly fail to report incidents. 
  
Partnerships With MFCUs and Law Enforcement and Using Data To Protect Programs  
 
Medicaid Fraud Control Units (MFCUs), the State agencies authorized to fight fraud and prevent 
patient abuse and neglect, are key partners in battling fraud and abuse in Medicaid.  In FY 2017, 
MFCUs reported more than 1,500 convictions, nearly 1,000 civil settlements and judgements, 
and more than $1.8 billion in criminal and civil recoveries.  OIG partners with MFCUs in joint 
investigations to hold wrongdoers accountable, recover stolen taxpayer dollars, and send a 
strong message to deter wouldbe fraudsters.  
 
OIG provides oversight and administers the grants that fund the MFCUs.  In this role, OIG 
continually strives to maximize the effectiveness of State MFCUs, thereby empowering States 
to better serve their populations.  OIG actions to drive the effectiveness of MFCUs include 
enhancing OIG oversight using a datadriven risk assessment to target engagement, improving 
MFCUs capabilities through training, increasing law enforcement collaboration between 
MCFUs and OIG, and working to help the MFCU program obtain resources consistent with an 
evolving Medicaid program.  
 
Although Medicaid has grown substantially since 2010, the fraudfighting resources of the State 
MFCUs have not kept pace.  The 50 existing MFCUs receive 75 percent of their funding on a 
matching basis from the Federal Government but often they encounter severe restrictions on 
their ability to maintain or expand staff.  In addition to the challenges of securing State
appropriated dollars for the MFCU match, some Units have difficulty in recruiting and retaining 
staff because of salary limitations. 
   
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Senate Committee on Homeland Security and Governmental Affairs 
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Between FY 2010 and 2017, while total MFCU staff resources increased 11.5 percent, total 
Medicaid expenditures for both Federal and State Governments increased 50 percent.  In 2010, 
each MFCU employee had oversight responsibility for nearly $218 million in program 
expenditures, but by FY 2017 that ratio increased, and each MFCU employee was responsible 
for overseeing nearly $293 million.  MFCUs are a wise investment, offering an estimated return 
of $6.52 for every $1 invested.   
 
Conclusion 
 
Effectively overseeing Medicaid remains a top management challenge for HHS.  OIG has offered 
several suggestions to improve Medicaid program operations, including the following 
unimplemented recommendations: 
  CMS should ensure that national Medicaid data are complete, accurate, and timely. 
 
  CMS should facilitate State Medicaid agencies efforts to screen new and existing 
providers by ensuring the accessibility and quality of Medicares enrollment data. 
 
  CMS should pursue a means to compel manufacturers to correct inaccurate 
classification data reported to the Medicaid Drug Rebate Program. 
 
  CMS should require States to either enroll PCS attendants as providers or require PCS 
attendants to register with their State Medicaid agencies and assign each attendant a 
unique identifier. 
 
 
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Senate Committee on Homeland Security and Governmental Affairs 
June 27, 2018  OIG plans to continue prioritizing Medicaid oversight to prevent and detect fraud, waste, and 
abuse, and take appropriate action when fraud, waste, or abuse occur. 
 
OIG has the capacity to leverage advanced data analytic techniques to detect potential 
vulnerabilities and fraud and better target our resources to those areas and individuals most in 
need of oversight.  However, to date, this innovative way to enhance and strategically target 
our oversight efforts cannot be accomplished in Medicaid without better quality, national 
Medicaid data.  This is the consistent crosscutting impediment to effective prevention, 
detection, and enforcement within the Medicaid program.  While neither CMS nor State 
Medicaid agencies presently command the data necessary to optimally support a 21st century 
Medicaid program, we believe this committees continued oversight will help achieve this goal.  
Thank you for your ongoing leadership and for affording me the opportunity to testify on this 
important topic. 
 
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