How ‘pay and chase’ works
In fiscal 2017, state Medicaid processed just under $567,000 in payments to providers through a specific case management billing code used in behavioral health. The next year, use of that code skyrocketed.
Medicaid investigators began examining the billings to see if providers were using it to submit fraudulent bills. They reached out to providers and gave them a chance to seek education through Medicaid if it was clear the improper billing was unintentional.
At the end of the process, Medicaid recovered $6.3 million in improper payments — more than 1,000 percent more than they clawed back in that category the previous year.