Medicaid Integrity Program Centers for Medicare

1
Medicaid Integrity Program Centers for
Medicare Medicaid ServicesCenter for Medicaid
State OperationsMedicaid Integrity Group

• 23rd Annual NAMPI Conference
• Coronado, CA
• August 27, 2007

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Deficit Reduction Act of 2005 MIP Statutory
Requirements

• Created Medicaid Integrity Program (MIP)
• Contracts for Claims Review, Audits, Overpayment
  Identification Education
• Effective Support and Assistance to States

3
Deficit Reduction Act of 2005 MIP Statutory
Requirements

• 5-Year Comprehensive Medicaid Integrity Plan
• - required consultations
• - http//www.cms.hhs.gov/DeficitReductionAct/
• Annual Report to Congress
• Dramatically Increased Resources of CMS to Fight
  Medicaid Fraud
• Funding
• Staffing

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Medicaid Integrity Group

• Division of Medicaid Integrity Contracting
• Oversees Contractor Procurement, Oversight, and
  Evaluation
• Develops Medicaid Integrity Contractors
• Division of Fraud Research Detection
• Identifies Fraud Trends and Share with
  Contractors and States
• Creates E-Library to House Medicaid-Related
  Reports / Information
• Conducts Special Studies

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Medicaid Integrity Group

• Division of Field Operations
• - 40 Field Specialists in New York, Atlanta,
  Chicago, Dallas, and San Francisco
• - Conduct Program Integrity reviews
• - Works with MIP Contractors, States in
  Connection with Audits, Reviews
• - Provides Other Assistance to States in
  Connection with Anti-Fraud Activities

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MIP ADVISORY COMMITTEE ongoing consultation
with strategic partners

• MEETINGS 12/06 and 03/07
• SUBCOMMITTEES
• - AUDIT
• - RETURN ON INVESTMENT
• - PERFORMANCE MEASUREMENT
• - MANAGED CARE

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MIP BUSINESS LINES

• MEDICAID INTEGRITY CONTRACTING
• 2. EFFECTIVE SUPPORT AND ASSISTANCE TO STATES

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MEDICAID INTEGRITY CONTRACTING Contractor
Responsibilities

• Review of Providers
• Audit of Providers and Others
• Identification of Overpayments
• Education of Providers and Others

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MEDICAID INTEGRITY CONTRACTING Contractor
Procurement

• Audit Contractors
• - Released Request for Proposal - July 11th
• - Proposals received August 14th
• Review of Providers
• - Released RFP July 20th
• - Proposals received August 20th
• Test Audits
• - Four pilot states Washington, Florida,
  Mississippi, Texas

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Support and Assistance to States

• Fraud Research
• State Program Integrity Oversight
• Investigative Support and Coordination
• Training, Technical Assistance and Best Practices
  Guidance

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SUPPORT AND ASSISTANCE TO STATES Training and
Technical Assistance

• One Stop Shop
• Training Conferences
• National PI Institute

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TRAINING TECHNICAL ASSISTANCE One Stop Shop
Project

• Improve Medicaid enrollment process
• Be responsive to GAO and Congress
• Consolidate the 600 unique Medicaid provider
  enrollment forms
• Consolidate the 50 Medicaid enrollment systems
• Significant Federal and State savings
• Improve front-end safeguards

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TRAINING TECHNICAL ASSISTANCE Short-term

• TRAINING CONFERENCES
• 2006 and 2007 Advance Med Statistical Training
• CPT Coding

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TRAINING TECHNICAL ASSISTANCE Long-term

• National PI Institute
• DOJs National Advocacy Center
• 5 year project
• Support state training and travel
• Certification programs
• Accreditation programs
• One-on-one TA to states

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Current Events

• Release of FY 2007 Comprehensive Medicaid
  Integrity Plan - August
• State Medicaid Director Letter Concerning new
  Federal Law Requiring Tamper-Resistant
  Prescription Pads for Medicaid Prescriptions
  August
• Test Audits in Four States - September
• Hiring of Field Operations, Other Medicaid
  Integrity Group Staff - ongoing

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Upcoming Events

• Development of State Program
• Integrity Metrics
• 3-Year Cycle for Program Integrity Reviews
• Ongoing work with Advisory Committee
• CPT Coding Training
• Development of National PI Institute

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Questions?

• Paul Miner
• 410-786-5937
• Paul.Miner_at_cms.hhs.gov
• Mary Linda Morgan
• 410-786-2011
• MaryLinda.Morgan_at_cms.hhs.gov
• Medicaid_Integrity_Program_at_cms.hhs.gov