NASO 2006

1
Washington State Medi-Medi Project
Experience Bob Covington, CPA Director of
Audit Information Systems Health and Recovery
Services Administration Washington Department of
Social and Health Services
National Association of Surveillance Officials
(NASO) 2006 Conference
2
Project Initiation and Structure

• Washington kicked off the Medi-Medi project in
  October 2004 and began development of the project
  governance and infrastructure to include
• Execution of Joint Operating Agreement
• Execution of Computer Matching Agreement
• Establishment of Steering Committee
• Washington established a structure intended to
  align Medi-Medi with existing payment integrity
  operations that Washington has had in place since
  2000 (data mining, algorithms, models).

3
Project Initiation and Structure

• Lessons Learned
• Move quickly to execute the CMA.
• Need for mutually agreed upon integrated project
  work plan and project controls.
• Early recognition of state resource impacts, to
  include state and contracted IT/FADS resources.

4
System Development

• Development of the Medi-Medi system was a long
  process, with the system brought into full
  production in Spring of 2006. Lessons learned
  include
• Early initiation and resolution of connectivity
  issues for data exchange
• CMS secure e-mail
• ConnectDirect data transfer (limited to mainframe
  to mainframe transfer)
• Effective data mapping requires significant
  face-to-face contact by knowledgeable Medicare
  and Medicaid staff.
• Staff participating in data validation should be
  trained and brought into the process early.

5
Data Analysis Case Review

• The project is in early stages of data analysis
  and case review.
• Early leads have generally been the result of
  independent data mining activities of the
  contractor and significantly weighted to
  providers of Medicare services.
• The project is currently working toward a more
  collaborative approach, bringing Medicare and
  Medicaid experts together to identify
  vulnerabilities. Emphasis will be placed on
  maximizing use of the combined Medicare and
  Medicaid data.

6
Data Analysis Case Review

• Lessons learned
• Establish early agreement to focus on data
  analysis and case review that maximizes the value
  of the combined Medicare and Medicaid data.
• Ensure state, federal, and contracted resources
  are available to collaboratively identify
  vulnerabilities.
• Consult early with law enforcement
  representatives.

7
Next Steps for Washington Medi-Medi

• Pursue additional resources that will be
  necessary to support increased state
  participation in identification of Medi-Medi
  vulnerabilities, data analysis, and case
  development.
• Collaborate with CMS to ensure appropriate level
  of effort and focus is placed on the combined
  data and that Medicaid is an equal partner.

8
Next Steps for Washington Medi-Medi

• Evaluate long-term viability of Medi-Medi in
  Washington
• Calculate and monitor Return On Investment
• Evaluate benefit of Medi-Medi in contrast to
  existing Washington Audit and Payment Review
  Program activities.

9
QUESTIONS?

• Bob Covington, CPADirector, Division of Audit
  Information SystemsHealth Recovery Services
  AdministrationWA Department of Social and Health
  ServicesPhone 360-725-2137E-mail
  covinbp_at_dshs.wa.gov