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Health officials describe fraud-detection upgrades, say most errors are administrative
Summary
The Department of Health detailed program-integrity operations, investigations, provider outreach and a newly purchased fraud-detection system that uses a library of analytic models to flag outliers for review.
Department officials told the appropriations subcommittee how the state identifies improper Medicaid payments and pursues recoveries while emphasizing front-end controls and provider education.
"We have our own internal program integrity section, and they work on identifying any payment irregularities," Jesse Springer said, describing audits, data mining, provider self-audits and referrals. Springer told the committee the department sometimes asks providers to perform self-audits when errors look unintentional.
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