A recent GAO review of Medicaid claims in four selected states (Arizona, Florida, Michigan, and New Jersey) discovered that thousands of Medicaid beneficiaries and hundreds of providers were involved in potentially improper or fraudulent payments during FY 2011. Such potentially improper payments involved, among other things, beneficiaries concurrently receiving benefits paid by two or more states, payments made to providers on behalf of deceased or incarcerated beneficiaries, and payments made to providers with suspended or revoked licenses. While CMS has taken steps to strengthen Medicaid enrollment screening controls, the GAO asserts that gaps remain. In the report, "Medicaid: Additional Actions Needed to Help Improve Provider and Beneficiary Fraud Controls," the GAO recommends that CMS issue guidance to states regarding: (1) identification of beneficiaries who are deceased; and (2) the availability of automated information through Medicare's enrollment database (the Provider Enrollment, Chain and Ownership System or PECOS).
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