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Securing Medicaid and Medicare Payments to Providers

Federal and State Governments reimburse health care providers and facilities electronically for providing health care services. Sometimes a provider or facility may change financial institutions to receive payment by using an electronic funds transfer (EFT) authorization request. However, since at least 2020 OIG has investigated schemes that have allegedly exploited vulnerabilities in EFT authorization forms to redirect provider reimbursements to their own bank accounts. Many State Medicaid agencies and Medicare Administrative Contractors (MACs) have been victims of this type of fraud over the past 3 years. We will collect information from States, MACs, and Medicaid Managed Care Organizations about EFT vulnerabilities and assess the feasibility of possible solutions to strengthen EFT fraud prevention efforts. In addition, we will collect information about any actions taken by CMS to address EFT fraud and assess the feasibility of CMS systems playing a role in fraud prevention efforts.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
February 2023 Centers for Medicare and Medicaid Services Securing Medicaid and Medicare Payments to Providers Office of Evaluation and Inspections OEI-07-23-00180 2024