Oz gives states 30 days to plan for Medicaid provider revalidation as part of CMS fraud audit

The Centers for Medicare & Medicaid Services (CMS) said it will task all 50 states with the development of plans to revalidate Medicaid-eligible providers, in an effort to crack down on fraud, waste and abuse linked to the safety-net health insurance program.

CMS Administrator Mehmet Oz, MD, made the announcement during Politico’s Health Care Summit on Tuesday, where the former television star rejected any insinuation that he and President Donald Trump are looking to squash the program, which will be subjected to hundreds of billions of dollars in federal spending cuts over the next decade.

“I love Medicaid. I cannot say that more fervently, and when you love something, you protect it. You don’t let it get defrauded,” Oz said.

The revalidation effort is part of a larger audit the U.S. Department of Health and Human Services (HHS) is conducting on Medicare, Medicaid and other social services. Oz emphasized that states will be responsible for ensuring providers who bill Medicaid for services are all properly licensed and operating within the confines of the law.

He added that CMS is “asking the states to own that problem” and that governments in both “red and blue” areas of the country will have 30 days to submit plans for how they intend to screen providers.

This will include identity and license checks to verify that organizations and individuals who bill Medicaid as providers are who they say they are. Low response rates, Oz emphasized, will indicate to the federal government that a specific area is a hotbed for fraudulent activity.

"The basic thing you'd want to do, if you actually cared about the program, is to make sure that legitimate providers are providing services that you're paying for and doing it the right way," Oz added.

He asked states to please take this seriously, saying that a failure to do so “indicates to us that we might have to take the audits… more aggressively.”