Report: UnitedHealth's Medicaid fraud oversight inadequate


A UnitedHealth subsidiary operating in New Jersey failed to properly prevent fraud from the state's Medicaid program, according to a report from the New Jersey Office of the State Comptroller.

Specifically, UnitedHealthcare Community Plan of New Jersey didn't hire and train enough fraud investigators, which violates its contract with the state, the report found. The comptroller's review also determined UnitedHealth "overstated" its staff levels and didn't require its special investigations unit to focus on fraud detection.

The comptroller's office pointed to the fact that UnitedHealth only recovered $1.6 million in improper Medicaid payments in 2009 and 2010--less than $1 for every $1,000 it received in tax money for the program. Meanwhile, the comptroller's own Medicaid fraud unit recovered more than $100 million in improper payments in 2012, reported The Star-Ledger.

"With billions of tax dollars flowing through New Jersey's Medicaid program, our state relies on its Medicaid HMOs to fulfill their oversight responsibilities in an aggressive manner," Comptroller Matthew Boxer said Wednesday in a statement. "This is another audit that shows an HMO failing to live up to requirements designed to combat fraud and lower state Medicaid costs."

In response to the audit, UnitedHealth said it would correct most of the problems identified, including changing its staffing levels and training procedures. The company also will ensure "all investigative activities will be conducted by trained SUI (special investigations unit) investigators," UnitedHealth's Vice President for Investigations Richard Munson wrote in a letter included in the audit report.

To learn more:
- here's the statement and report (.pdfs)
- read The Star-Ledger article

Related Articles:
Fraud investigations to decline with OIG budget cuts
CA investigators halt Medicaid payments to 16 providers
Fraud prevention: Decipher the claims data story
Layoffs, budget cuts hamper Medicare anti-fraud efforts
Former WellCare execs guilty of fraud