North Dakota Launches New Medicaid Fraud Prevention Strategy

BISMARCK, N.D. — Gov. Kelly Armstrong announced that North Dakota Health and Human Services launched a new two-year strategy to strengthen oversight, prevent fraud, and ensure the integrity of the state’s Medicaid program, with enhanced scrutiny of three high-risk provider categories set to begin July 1.

The strategy was developed in response to an April 23 letter from the U.S. Centers for Medicare and Medicaid Services directing states and territories to accelerate provider revalidation activities and develop comprehensive, long-term plans to ensure only qualified and legitimate providers participate in Medicaid.

Beginning July 1, North Dakota will expand oversight of qualified service providers, non-emergency medical transportation providers, and 1915(i) providers — categories identified as more vulnerable to fraudulent activity. Providers in these categories often work as independent contractors, operate with limited outside credentialing requirements, deliver services in home and community-based settings, and have not consistently used National Provider Identifiers required for Medicaid billing. Enhanced measures will include more frequent revalidations, stricter enrollment requirements, increased competency assessments, site visits, and a provider enrollment moratorium for certain areas.

HHS Commissioner Pat Traynor said the department was standing up both an Office of Program Integrity and an Office of Performance Metrics to support the expanded oversight effort, calling the revalidation strategy a complement to existing anti-fraud measures already in place.

Armstrong said the majority of Medicaid providers operate in good faith and that the expanded oversight was designed to strengthen the program for recipients, health care providers, and taxpayers alike. He credited Administrator Dr. Mehmet Oz, Secretary Robert F. Kennedy Jr., and President Trump for working with the state on Medicaid program integrity.

The two-year strategy does not include revalidation of Medicare-enrolled providers, as North Dakota follows the existing federal screening and revalidation process administered through Medicare.

By: Digital News Updates Newswire