Medicaid Integrity Program - PowerPoint PPT Presentation

1 / 16
About This Presentation
Title:

Medicaid Integrity Program

Description:

5-Year Comprehensive Medicaid Integrity Plan. http://www.cms.hhs.gov/DeficitReductionAct ... Medi/Medi Combines Medicaid and Medicare Data. 10 States Participate ... – PowerPoint PPT presentation

Number of Views:111
Avg rating:3.0/5.0
Slides: 17
Provided by: temp393
Category:

less

Transcript and Presenter's Notes

Title: Medicaid Integrity Program


1
Medicaid Integrity Program
  • Deficit Reduction Act Initiatives

2
DRA MEDICAID INTEGRITY PROGRAM
  • 5-Year Comprehensive Medicaid Integrity Plan
  • http//www.cms.hhs.gov/DeficitReductionAct/
  • Audit Medicaid Providers
  • Annual Reports to CongressReturn on Investment
  • National Medicaid Program Integrity Advisory
    Committee
  • Coordinate with States and Other Federal Agencies

3
Contracts for claims review, audits, overpayment
identification education
  • Audit Providers
  • Refer suspected fraud cases to OIG
  • Regional Contracts
  • Recover federal share of overpayments
  • Assist states in collection of overpayments
  • Educate Providers

4
Effective Support and Assistance to States
  • Program Integrity Protocols Reviews
  • Fraud Science/Research
  • Training Opportunities
  • Regional Conference Calls
  • CMS Field Staff

5
Additional CMS Resources
  • 100 New CMS FTEs
  • 20 Medi/Medi and PERM
  • 80 CMS PI Central Office and Field Ops
  • 5 million in FFY 06
  • 50 million in FFY 07 and FFY 08
  • 75 million annually by FFY 09

6
CMS Medicaid Integrity Group
  • Division of Medicaid Integrity Contracting
  • Oversee strategic contractors
  • Procure and monitor Medicaid contracts
  • Division of Fraud Research Detection
  • Investigate emerging trends
  • Develop prevention measures
  • Division of Field Operations
  • State PI oversight
  • Technical assistance

7
OTHER DRA PROVISIONS
8
Medi/Medi Expansion
  • Medi/Medi Combines Medicaid and Medicare Data
  • 10 States Participate
  • DRA Encourages National Expansion
  • DRA Provides 60 Million Annually
  • State Coordinating Committee
  • Provision in 2007-09 WI Budget Proposal

9
Assistance to OIG
  • 25 Million Annually
  • Additional Training
  • New Resources
  • Additional Audits
  • Improve Fraud Referral Processes

10
False Claims Education
  • Entities Receiving or Paying Over 5 million in
    Annual Medicaid Payments Must Develop and
    Maintain an Employee Education Program Related to
    Federal FCA, State FA Programs and Whistleblower
    Provisions
  • Condition of Participation in Medicaid
  • Also Applies to Contractors
  • State Enforcement

11
State False Claims Act
  • Encourage States to Enact FCAs
  • Acts Must Meet Federal Standards
  • State Using a State FCA May Retain a Higher
    Percentage of Recovered Overpayments
  • Language in 2007-09 WI Budget Proposal

12
MIP Implementation
  • Ongoing consultations with partners
  • Medicaid Advisory Committee
  • Strategic contractors
  • Medicaid Integrity Audit Program
  • State Program Integrity Assessment
  • Statutory regulatory review
  • Education and training

13
What Does MIP Mean for States?
  • Previous to DRA, CMS provided broad policy
    guidance and limited oversight of PI functions
  • MIP requires closer review of state actions
  • MIP provides funding for additional assistance,
    training and support
  • MIP requires that CMS audit providers
  • MIP requires that CMS coordinate its activities
    with state and other federal agencies

14
MIP Challenges
  • Ensuring coordination with state audit activities
    and OIG audits
  • Ensuring understanding of different state program
    requirements and processes
  • Identifying and sharing best practices
  • Identifying states needs and providing resources
    to best address those needs
  • Avoiding negative impact on access to care

15
CMS Referral Training
  • Update and Publish MFCU/Program Integrity Best
    Practices Manual
  • --Listing of MFCU and PI Directors
  • --Rules and Responsibilities
  • --Description of CMS Integrity Program
  • --Sample MOUs
  • --False Claims Act Information
  • --Referral Techniques
  • --Cross Training Events
  • Other Training Opportunities

16
QUESTIONS
Write a Comment
User Comments (0)
About PowerShow.com