The Department of Public Welfare saved taxpayers nearly $690 million in the 2009-10 fiscal year through fraud and abuse detection and other cost-recovery efforts, Public Welfare Secretary Harriet Dichter said today.
"These savings reflect the dedication and commitment DPW has to serving all Pennsylvanians," Dichter said. "Just as the department has an obligation to serve the one in six Pennsylvanians who rely on the vital programs we administer, we also are obliged to use resources efficiently on behalf of every taxpayer."
The savings included:
- More than $614 million in costs avoided or recovered from private insurers and other third-party sources for services that otherwise would have been paid through state-funded Medical Assistance.
- $75 million through the department's fraud and abuse detection, cost avoidance and recovery efforts.
DPW uses sophisticated fraud and abuse detection software that analyzes 27 million Medical Assistance claims each year to find data patterns that indicate potential fraud by providers or recipients.
In addition, the department works to identify Medical Assistance consumers who have overused or misused services. DPW requires these consumers to get selected services from a single provider of their choosing to ensure a more appropriate use of services, helping to curb unnecessary costs.
The department also uses a third-party liability review to examine whether Medical Assistance consumers are eligible for Medicare or have private insurance that could pay for some or all of their services. For example, a Medical Assistance consumer injured in a car accident might be able to have their care paid for by their auto insurance company.
"By collecting payments from other liable sources, DPW can keep Medical Assistance costs as low as possible, which allows us to stretch those dollars to serve more Pennsylvanians in need," Dichter said.
The federal government requires Medical Assistance programs to be used as the "payer of last resort," the secretary noted.
In addition to these cost recovery efforts, the department also works continuously to detect potential fraud and abuse, including requiring applicants for public assistance to undergo more than a dozen different checks related to income, other financial resources and criminal history.
For more information about the Department of Public Welfare's efforts, visit www.dpw.state.pa.us.