Anonymous-CA

According to the GAO (see report GAO-04-707), “Out-of-date information increases the risk that Medicaid will pay individuals who are not eligible to bill the program. For instance, in California, individuals were found to have falsely billed the Medicaid program using the provider billing numbers of retired practitioners. Forty three states reported that, at a minimum, they cancel or suspend inactive provider billing numbers.” In addition, GAO-04-707 list the 43 states that cancel or suspend inactive Medicaid billing privileges. Accordingly, I recommend that CMS explain why it will allow State Medicaid Agencies to cancel or suspend inactive physician and non-physician Medicaid billing numbers, but is proposing to discontinue a similar practice in the Medicare program. I recommend that CMS explain why it is establishing different deactivation policies for physician and non-physician practitioners in the Medicare and the Medicaid program. I also recommend that CMS explain why it disagrees with the GAO statement in GAO-04-707 that “Out-of-date information increases the risk that Medicaid will pay individuals who are not eligible to bill the program” and why this policy change decreases risk to the Medicare program.