Faulty Medicaid fraud databases seen costing Fla. millions

Faulty databases at the Florida Legal Affairs Department's Medicaid Fraud Unit have denied the state millions of dollars from fraud loss recovery, state auditors reported.

The fraud unit investigates and prosecutes corruption in Florida's Medicaid program. The unit looked at 664 cases between July 2001 and January 2003, about a quarter of which led to convictions or settlements totaling $24.7 million, according to a report from the office of auditor general William O. Monroe.

The auditors found that "department data systems were not complete and accurate, inhibiting computation and reporting of overpayments and costs associated with investigation and prosecution," their report said.

The fraud unit uses three separate databases to track cases, employee time and case expenses associated with Medicaid abuse. An audit of 60 cases found that 28 of them, or 47 percent, were not properly recorded by the case-tracking database. Additional database errors led to a $2.4 million understatement of restitution due to the state.

In addition, the auditors found that the time tracking database had recorded only one-third of the time spent by investigators and attorneys on fraud cases. The auditors said fraud unit officials "acknowledged the inadequacies with the current systems and indicated that the department?is in the process of redesigning the systems used to track time and other costs associated with case investigations."

The auditors called for additional review and reconciliation of the databases plus better procedures for using them.

Wilson P. Dizard III writes for Government Computer News