TRENTON – The battle against fighting Medicaid fraud and abuse needs to shift away from the “pay and chase” model, says the director of the state’s agency tasked with tracking Medicaid waste in New Jersey.
“My views are that prevention is much better,” said Mark Anderson, director of the Medicaid Fraud Division of the Office of the State Comptroller, speaking to the Senate Legislative Oversight Committee Monday afternoon.
“If we’re constantly doing pay and chase we’ll be doing that forever,” he said.
Anderson was one of several individuals invited to testify before the committee on the state’s current efforts aimed at preventing Medicaid fraud and abuse in New Jersey.
He said the traditional model of combating Medicaid fraud is essentially based on tracking down offenders after money has already been doled out. He said there’s a newer effort to use a sort of predictive policing model, which uses technology to essentially predict areas of potential fraud and find solutions before money is spent.
Senate lawmakers said they hoped to understand where New Jersey ranked in Medicaid fraud compared to other states, but since Medicaid implementation varies from state to state, it’s hard to give an accurate number, Anderson said.
“It’s tough to take what I would say is a national average and apply it to New Jersey,” he said. “The fact of the matter is we don’t know the exact (national) percentage.”
According to several estimates, between 3 percent and as much as 30 percent of Medicaid dollars spent, nationwide, are paid out in fraud or abuse of the system, Anderson said. The estimates are from various studies, but, Anderson pointed out, the fact remains abuse is hard to track and a national average is speculative at best, he said.
