October 10, 2015
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Serpa makes Medicaid fraud priority for legislative session

Rep. Patricia A. Serpa (D-Dist. 27, West Warwick, Coventry, Warwick) has introduced a House resolution requesting Gov. Lincoln Chafee to implement programs and methodology to improve the program integrity of both Medicaid and the Children’s Health Insurance Program (CHIP) in the state.

The House Finance Committee will hear the bill tomorrow at 2:30 p.m. in Room 35 of the State House.

“As with everything, it’s all about having the right tools at your fingertips,” the representative said in a statement. “There have been talks about cutting services to generate a balanced budget, but there are surefire ways to save the state money and fill in the gaps here – this is one of them. We can’t continue to slash services when we haven’t taken the necessary steps here to prevent massive amounts of waste and fraud. This needs to be a top priority before we even consider taking another step forward with the budget.”

The resolution (2012-H 7235) requests that the governor seek to shift the programs from a retrospective “pay and chase” model to a pre-payment model. It also asks the state Department of Human Services to implement provider data verification and screening technology solutions to check health care billing, as well as provider rendering data against a well-maintained provider information database.

Furthermore, the resolution states that the department should implement state-of-the-art clinical code editing technology solutions to enhance cost containment. The technology would be critical to preventing any kind of errors, including potential overbilling or inappropriate payments to deceased and sanctioned providers. The upgrade would also make the state capable of confirming wrong addresses and sending a red flag to the department when a provider has either retired or carries an expired license.

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