Waltz Discusses Improper Medicaid Payments

Partner Judy Waltz was quoted in a Bloomberg Law article, “Medicaid Wastes Billions Despite Warnings,” about Medicaid’s failure to eliminate improper payments to states despite government recommendations to do so. The program’s longstanding problem with enrolling providers and correctly identifying practitioners’ information are two of the chief issues behind the wasteful spending.

“It seems like the identified issues with provider enrollment are much more easily fixable than medical necessity or outright fraud, and provider enrollment has been a priority with [the Centers for Medicare & Medicaid Services], but first they need to figure out what they should do to fix the problem,” Waltz said. She explained that states have had years to implement provider enrollment systems, but such systems “take resources from the state that may not be fully supported with federal funds.”

Waltz added that CMS stopped pursuing a system for all state programs to use a single federal Medicaid provider enrollment process, “but that might be one way to address what seems to be a continuing problem already several years in existence.” She also emphasized that Medicaid is comprised of individual state programs with their own requirements; it is not one program.