1 / 5

Medicaid Integrity Program

Medicaid Integrity Program. … and other issues. The Medicaid Integrity Program. Managed by CMS – not OIG The Medicaid Integrity Group David Frank, Director – former prosecutor Support not supplant state efforts – however, is expected to put a lot of pressure on states to perform

lidia
Download Presentation

Medicaid Integrity Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medicaid Integrity Program … and other issues

  2. The Medicaid Integrity Program • Managed by CMS – not OIG • The Medicaid Integrity Group • David Frank, Director – former prosecutor • Support not supplant state efforts – however, is expected to put a lot of pressure on states to perform • Three divisions: • Medicaid Integrity Contracting: procurement and oversight of contractors • Fraud, Research and Detection: data-mining • Field Operations: offices in Chicago and 4 other states • Special support to states

  3. The Medicaid Integrity Program • Three sets of contractors form based of program • Review MIC (Medicaid Integrity Contractors) – data mining • Audit MICs – field and desk audits – work with DOJ and OIG to make sure not duplicating or interfering • Not contingency based contracts • FFS claims and then cost reports; next managed care audits • Identify but do not collect overpayments • Do NOT identify underpayments – SEE HANDOUT • Education MICs: state and providers; Medicaid Institute for states run conjointly by the DOJ and CMS

  4. The Medicaid Integrity Program • Issues: • Contractors must learn on their own • Most audits will be desk audits • Requests will come on the contractors letterhead – may end up with a CMS cover letter but not yet – WATCH for these requests • In some cases identifying consumer only by Medicaid # • No limits on numbers of records that can be requested – they will not pay for copies • Illinois has a very short window for appeals • They will not be posting audits

  5. New Federal Compliance Issues • New York OMIG: work plan, required compliance programs – setting new benchmarks • Quality of Care: • Medical Services: off-label usage; under 14; drug-seeking parents; cocktails, etc. • Board of Directors • Quality and Compliance and Risk Management and UR – no silos • IMD: not settled; Georgia advice remains best but not necessarily workable • Family-based interventions – engagement and outcomes

More Related