Medicaid Fraud and Abuse Provisions: Changes Under the Deficit Reduction Act of 2005  

Although Medicare fraud and abuse garners more attention in the industry, Medicaid fraud and abuse has also been a drain on the federal budget. In an effort to reduce Medicaid waste, President George W. Bush signed the Deficit Reduction Act of 2005 (DRA) into law in February of this year. The DRA contains many provisions reforming Medicare and Medicaid that are estimated to reduce program spending by $11 billion over five years.

The DRA takes a multi-faceted approach to cracking down on Medicaid fraud, waste and abuse by: creation of a federal Medicaid Integrity Program; expanded funding for Medicaid fraud enforcement; incentives for states to adopt whistleblower programs like the federal False Claims Act (FCA); and the requirement that certain providers "self-police" potential Medicaid fraud, waste and abuse by adopting new policies and educating employees. Providers should be ...