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Puerto Rico Gov’t Continues Work to Prevent Medicaid Fraud

By on October 26, 2018

Editor’s note: The following originally appeared in the Oct. 25-31, 2018, issue of Caribbean Business.

After Gov. Ricardo Rosselló enacted the Fraudulent Claims to the Programs, Contracts & Services of the Government of Puerto Rico Act in July, both the Health and Justice departments have continued to work on implementation of the Medicaid Management Information System (MMIS) and Medicaid Fraud Control Unit (MFCU) to address fraudulent claims against Medicaid.

As the government seeks to increase data collection and build a fraud prevention mechanism to secure a $1.2 billion allocation from Congress through the Bipartisan Budget Act of 2018’s Disaster Relief Funds, the MMIS, which was established in March 2018, is expected to be fully implemented by December 2019.

Meanwhile, the Health Department’s press secretary said that although there is a task force assigned to work with both the MMIS and the MFCU, once the program is fully implemented, they will access those Medicaid funds.

The secretary of the Justice Department, Wanda Vázquez, announced in a release that the agency already began to work to create the MFCU through an administrative order, saying that “dealing with the loss of public funds assigned to our island is of paramount importance to ensure the trust of the government of the United States in our [Puerto Rico’s] government agencies. A strong message is also sent to those who defraud and profit at the expense of the need of other people.”

As this newspaper was going to print, a status update requested by Caribbean Business from the Justice Department on the MFCU’s progress remained unanswered.

Aside from freeing up additional funding from the congressional recovery package approved after Hurricane Maria, Health Secretary Rafael Rodríguez Mercado previously argued it could help Puerto Rico better manage existing funds as well as assist government officials to have more credibility when asking for additional funding unrelated to hurricane recovery efforts.

Beyond the recovery package, the Health secretary stressed, “This program [MMIS] is going to determine how much money Puerto Rico really needs so the Medicaid and local Mi Salud programs can function without problems.” This is because the MMIS is producing daily reports, “creating a record from which, at the end of the year, it will say how much money was spent from the federal allocations to the Medicaid program,” Rodriguez Mercado assured.

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