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Kentucky hires independent watchdog to prevent and recoup Medicaid abuse

By Phillips & Cohen LLP

The state of Kentucky has entered into a 3-year contract with Ingenix, a company that will use algorithms and other mathematical formulas to detect fraud and abuse in medical claims from Kentucky Medicaid providers.

A press release from Kentucky Governor Steve Beshear?s office reports that in addition to ?the latest computer technology available,? Ingenix will be ?conducting onsite audits, desk audits and pre-payment review,? and will additionally be charged with identifying areas for improvement in systems and process and suggesting measures to be taken.

Ingenix will be paid at the rate of 12.5% of the payments recouped using their fraud and abuse detection processes. ?In a program the size of Kentucky?s Medicaid program, which continues to grow both in costs and people served, having the most vigilant waste, fraud and abuse detection system in place is critical,? Governor Beshear stated.

Full post as published by False Claims Act - Qui Tam on October 20, 2010 (boomark / email).