Medicaid Claims Under Investigation for Provider Fraud Remain Part of Federal PERM Audits

CMS issued a final rule implementing changes to Payment Error Rate Measurement (PERM) in Medicaid and the Children's Health Insurance Program (CHIP). The final rule appears in the August 11, 2010 Federal Register (75 Fed. Reg. 48816).

According to a CMS press release, PERM measures improper payments in Medicaid and CHIP, and produces national-level error rates for each program. These reviews are conducted to determine whether the sampled cases meet appicable Medicaid and CHIP fee-for-service, managed care, and eligibility requirements.

PERM reviews sample claims from a defined set of Medicaid and CHIP claims. The final rule leaves Medicaid and CHIP claims under investigation for provider fraud in the set of claims to be sampled. Because claims under fraud investigation are subject to PERM review, providers can expect states to remain aggressive in handling the investigation and any subsequent legal action.

To learn more, please contact Ben Anderson at banderson@jeylaw.com or 404.995.6792.