Medicaid Integrity Plan - Essay Example

Medicaid is a government-initiated program that aims at assisting economically deprived individuals in meeting their health needs. However, following the several ethical instances surrounding the program, the government has designed several acts to help contain the undesired situation. False claim Act, Federal Deficit Reduction Act, and Medicaid Integrity Plan constitute some of the programs or laws enacted to watch the activities of Medicaid. These plans or laws help in controlling costs, abuse, and fraud, as discussed in this document.

False Claims Act False Claim Act is a Federal law in America, which puts liability on people and organizations that try to swindle government programs. This Act has been in place since the era of the Civil War, and it involves a number of aspects. For instance, when a private whistleblower, also called qui tam, files a legal suit in a court of law, he stands a chance of getting 30 percent of the compensation, in the absence of any government intervention. In addition, FCA deters individuals or organs from making false claims in order to receive extra payments from the government.

The act outlaws such unscrupulous actions posing them as criminal offenses thus punishable by law (Taylor, 2006). Medicaid Integrity Plan Medicaid Integrity Plan was started by the Centers for Medicare & Medicaid Services, denoted as (CMS), based on a certain government act of 2005. Under the Medicaid Integrity Plan, the CMS has a number of significant roles, which include offering necessary support and assistance to states for them to fight Medicaid fraud, and abuse by individuals and companies (Welch, 2006).

It also goes through various activities conducted by Medicaid providers, identifies overpayments through hired contractors, and educates the populace about integrity issues of Medicaid. Medicaid Integrity Plan (MIP) further ensures that many people register for the provider process, and moderates or regulates the medical fees paid for the medical services in Medicaid. Federal Deficit Reduction Act The Federal Deficit Reduction Act (DRA) is federal legislation signed into an act in 2005. The act has numerous provisions, among them being the one that allows the government to effect crucial changes in the Medicaid programs.

However, for these crucial changes to take place in the respective states, the exact date for the exercise must be carefully selected, in order for the process to be free from hitches. This legislation (DRA), furthermore, has made a significant cost cut for the unprivileged Americans, in offering healthcare services. However, the act has only helped the state in reducing funding for Medicaid programs that mostly affect the poor (Cona, 2006). Various ways each program helps in controlling costs The government has a number of ways at disposal to ensure Medicaid programs are managed effectively.

For example, it can use the False Claims Act (FCA), which puts a civil liability on individuals and organizations that give false or fake allegations to the government so that they can receive unaccountable payments from the government (Imperato, 2003). In addition, the state ensures offenders are not included in any other government-initiated programs such as Medicare and Medicaid. Furthermore, the government controls costs by encouraging and rewarding private individuals who expose fraud perpetrated against the state.

When it comes to Medicaid Integrity Plan, the government operates through the Centers for Medicaid and Medicare Services (CMS) to ensure states do not waste their funds. For example, CMS, through other related programs, ensures effective use of healthcare services by only authorized recipients and beneficiaries. In addition, CMS significantly reduces abuses and fraud cases found among providers of Medicare. Furthermore, the Secretary of Health and Human Services has the authority to hire suitable contractors to conduct audit functions and specified reviews (Anonymous, 2002).

The contractors conduct functions such as cost report audits, fraud reviews, and determinations of payments and recovery.

Federal Deficit Reduction Act (DRA) is legislation signed into law in 2005, specifically meant to control costs in imaging technologies. The DRA prohibited imaging in doctor’s offices and other outpatient facilities concerned with imaging found outside the hospital (Greene & Bowie, 2005). The government has discouraged imaging for people who want multiple images at once, even on medical procedures approved by doctors. Other medical sectors where the government is cutting costs include those using MRT, Ultrasound, bone densitometry, CT, and X-rays. In fact, the total savings reported by the Federal Budget was a reflection of the decreased expense in Medicaid programs.

How the Government is controlling costs and reducing Medicaid fraud

I believe the government is doing its best to control costs and reduce Medicaid fraud and abuses in many ways. For instance, the heavy fines imposed on those liable of False Claims Act and immediate exclusion from any other government programs such as Medicare and Medicaid (Imperato, 2003). Additionally, the fact that the False Claims Act is wide in the court of law ensures, any likelihood of trying to benefit from the government using any fraudulent methods is punishable by law. The FCA also recognizes conspiracy acts as a criminal offense and thus ensures offenders are jailed for many years with an imposition of a hefty fine.   

The government has also employed the use of technology such as information systems in paying claims on time and accurately. In addition, the system is used to spot and track any fraud and abuse that is about to be committed. The state also uses the system together with functional databases in the management and planning of Medicaid programs through the prioritization of activities. Furthermore, the government has come up with various legislations that make it hard for those involved in fraud and abuse cases in order to control costs (Galloro, 2001). For instance, the Medicare and Medicaid Fraud and Abuse Amendments of 1977 vividly defined offenses and raised penalties (Smith & Moore, 2008). In addition, this amendment compels providers to disclose all their activities and be cooperative during any government auditing process.