MedicareMedicaid Data Match Program

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Medicare-Medicaid Data Match Program

• Lourdes Grindal Miller
• Medi-Medi Program Lead
• Program Integrity Group
• Centers for Medicare Medicaid Services

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Medicare Medicaid Data Match Program

• Medi-Medi is a partnership between Medicaid and
  Medicare that enhances collaboration and reduces
  fraud, waste, and abuse
• Medi-Medi is accomplished by matching Medicaid
  and Medicare data to identify improper billing
  and utilization patterns. Medi-Medi includes
  state, regional, and national efforts and
  requires collaboration among state Medicaid
  agencies, CMS, and state and federal law
  enforcement officials.

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Current Medi-Medi States
NY
PA
NJ
OH
IL
CO
CA
NC
OK
TX
FL
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How Medi-Medi Works

• CMS funds and oversee the PSC/ZPIC
• Data warehousing, matching and analysis
• Medi-Medi Steering Committee
• Identification and prioritization of potential
  vulnerabilities
• Pursuing fraud, waste, and abuse leads generated
  by the program

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Implementing DRA

• CMS is in the process of procuring Zone Program
  Integrity Contractors (ZPICs), which will
  consolidate Medicare Parts A, B, C, D, and
  Medi-Medi Benefit Integrity Activities.
• Medi-Medi expansion began in fall of 2008.
• Zone 4 (CO, TX, OK) Health Integrity
• Zone 7 (FL) SafeGuard Services
• CMS is considering a regional approach to
  Medi-Medi.

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ZPIC Jurisdictions
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Results Since We Last Met

• 52 Referrals to Law Enforcement
• Over 23 Million in Overpayments
• 4.1 Million in Prepayment Review Denials

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Examples of 2008-2009 Projects

• Time Dependent Studies
• Facet Joint Injections
• PO Box used for Provider Service Address
• Ambulance Services
• Home Health Services

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Additional Benefits

• Medi-Medi National Coordinator
• Improved information sharing through a secure
  website
• Catalog of data analysis projects
• Document sharing
• Implementation support
• Cross Training
• Medicare and Medicaid
• Data analysis tools
• One PI
• Co-location opportunities
• Enhanced project and case tracking in the Fraud
  Investigation Database (FID)

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Joining Medi-Medi

• If your state is interested in becoming a
  Medi-Medi state or if you would like more
  information, please contact Lourdes Grindal
  Miller.

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Contact Information

• Lourdes Grindal Miller
• Centers for Medicare Medicaid Services
• 7500 Security Boulevard
• Mail Stop C3-02-16
• Baltimore, MD. 21244-1850
• Telephone [phone]
• lourdes.grindalmiller_at_cms.hhs.gov

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