House looks at Medicaid fraud units for territories

Sep 11, 2015

Included in the President’s fiscal 2015 budget proposal and introduced as legislation in the House this week by Chairman Joseph Pitts (R-Pennsylvania) is a response to the lack of Medicaid Fraud Control Units in any of the five U.S. insular areas. Mr. Pitts bill, H.R. 3444, also received a hearing today before the Health Subcommittee of the House Energy and Commerce Committee, which Mr. Pitts chairs. Since 1995, Federal law has required every state and territory to have a fraud unit. But neither American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico, nor the U.S. Virgin Islands governments have done so. The reason is simple: federal Medicaid funding for all these areas is capped at a set amount each year, so anything spent on fraud control would take away money for medical care. Mr. Pitts’ bill removes that disincentive by counting the cost of fraud control separate from the capped Medicaid grant. And President Obama’s budget proposal set aside $10 million in federal funds over a ten period to pay for Medicaid Fraud Control Units in the non-state areas.