Medicaid Integrity Program … and other issues. The Medicaid Integrity Program Managed by CMS – not OIG ▫The Medicaid Integrity Group ▫David Frank, Director.

Slides:

Advertisements

Similar presentations

Mount Sinai Medical Center Compliance Department If It Concerns You, It Concerns Us The Mount Sinai Hospital New York, New York How to Leverage a RAC Committee.

Advertisements

1 Program Integrity in Medicare and Medicaid Commonwealth of VirginiaMarch 5, 2012 Dr William A Hazel Jr. M.D. Secretary of Health and Human Resources.

Alliance for Health Reform Panel Briefing Doug Porter, Medicaid Director Director, Health Care Authority March 5, 2012.

The Keys to a Successful Audit Appeals Program Larry Hegland, MD, MMM System Medical Director for Recovery Audit and Appeal Services Chief Medical Officer:

Vendor Management September 7 th 2007 James Mahan, Vice President Yankee Alliance.

HEALTH LAW PRACTICE IN GOVERNMENT: HEALTH CARE FRAUD AND ABUSE 2009 ABA Health Law Section James G. Sheehan James G. Sheehan Medicaid Inspector General/former.

GRANT FRAUD AWARENESS GRANT FRAUD AWARENESS SA Laura Rousseau U.S. Department of Justice Office of Inspector General Fraud Detection Office.

Department of Human Services Division of Medical Services Eugene Gessow Director.

2011 Medical Professional Liability Symposium Chicago, IL ~ March 24 & 25, 2011 THE WRECK OF THE RAC: LESSONS LEARNED FOR ALL.

1 CMS Region C RAC Dr. James Lee, Medical Director.

Medicare Recovery Audit Contractors (RACs)

RAC Update RAC Update GAHA: 2014 Health Care Law Update May 16, 2014 Tracy M. Field, M.S., J.D. Womble Carlyle Sandridge & Rice, LLP th Street,

1 CMS Center For Program Integrity (CPI) Part D Recovery Audit Contractor (RAC) Program Overview Frank Chartier Division of Plan Oversight & Accountability.

DETERMINING WHETHER TO APPEAL RAC DENIALS Kathleen Houston Drummy Davis Wright Tremaine LLP.

When You Need and Don’t Need Legal Representation for OMIG (Former) Compliance Officer’s Perspective Laurie G. Radler, CHFP.

Medicare Recovery Audit Contractor (RAC) Program Jennifer Amann, MBA Healthcare Resource Providers, LLC.

January 2015 Mandatory Compliance Program and Certification Obligation Webinar # 24.

Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.

Managing Fraud Risk in Higher Education 2014 UNC Fall Controller's Workshop November 10, 2014 David A. King, CPA, CFE – Director, Special Investigations.

Coping with Regulatory and Payer Demands to Practice PM&R Bruce M. Gans, MD.

The ABC’s of Hospice, COP’s, ADR’s and RAC’s Kim Kranz, RN, MS Kathy Baker, RN, MSN.

Home Health Medicare Audits June 27, 2013 F.O.R.C.E. Healthcare Resources, LLC (Founded on Regulatory Compliance and Ethics)

PROGRAM INTEGRITY AND PROVIDERS IN MEDICAID MANAGED CARE Julia B. Sinclair, MSW, LCSW Sr. Director, Quality and Integrity Operations Smokey Mountain Center.

# Operating Under the New Compliance Environment: Considerations for the Pharmaceutical Industry The Impact of the new Medicare Prescription Drug benefit.

Medicaid Managed Care Basics Presentation to the Specialized Services Subcommittee September 13,

Robb Miller, Director Division of Field Operations CMS Medicaid Integrity Group Medicaid Integrity Program AHCA/NCAL 60th Annual Convention October 6,

© 2009 The McGraw-Hill Companies, Inc. All rights reserved. 1 McGraw-Hill Chapter 5 HIPAA Enforcement HIPAA for Allied Health Careers.

What To Look For In A Coding Audit Don’t Leave Money On The Table Wiks Moffat Laurie Zabel, CHC, CHPC, CPC.

Special Study: School-based Services Overview Medicaid Program Integrity March 5, 2013.

HEALTHCARE TRUSTEES OF NEW YORK STATE Compliance and Governance Update August 8, 2012.

DSDS Quality Assurance Unit State of Alaska, Dept. of Health and Social Services Division of Senior and Disabilities Services (DSDS) Quality Assurance.

Overview of ZPICs Curtis Watkins – Program Director

The Challenges of the Medicaid Modernization Mandate – Part 1 Joel L. Olah, Ph.D., LNHA Executive Director Aging Resources of Central Iowa Iowa Assisted.

Computerized Networking of HIV Providers Workshop Data Security, Privacy and HIPAA: Focus on Privacy Joy L. Pritts, J.D. Assistant Research Professor Health.

CMS Center For Program Integrity (CPI) Part D Recovery Audit Contractor (RAC) Program Overview Tanette Downs and Frank Chartier Division of Plan Oversight.

GEORGIA MEDICAID P ROGRAM I NTEGRITY AND RAC: W HAT Y OU C AN E XPECT IN 2014 P RESENTATION T O T HE H OME T OWN H EALTH 14 TH A NNUAL F ALL C ONFERENCE.

Customer-Centric Health Intelligence & Solutions Improving Health Outcomes for Medicare Beneficiaries: The Medicare, Medicaid and SCHIP Benefits Improvement.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative.

Looking for Improper Medicare Payments in All the Right Places.

Surprising Outcomes of CMS Program Audits of MA Plans Steve Bunde.

Revenue Integrity: Preparing for Contractor Combat East Tennessee Fraud Working Group Tennessee Hospital Association Fall Compliance Conference 2009 October.

Medicare Recovery Audits (RAC) Presented by: Shannon McGee, Director Florida Hospital Patient Financial Services

1 Investigating Fraud & Abuse Violations in Medical Research Janet Rehnquist, Esq. Venable LLP th Street, NW Washington, DC

Medicaid Program Integrity A View from the States National Medicaid Audioconference Combating Medicaid Fraud and Abuse October 24, 2006 Kathryn Kuhmerker,

1 Medicare Recovery Audit Contractors (RACs) George Mills Director, Provider Compliance Group Office of Financial Management Centers for Medicare & Medicaid.

HealthLine Systems, Inc. Internet Based Credentialing Presented by Cheryl Tensley.

Transition of Inpatient Hospital Review Workload Office of Financial Management Program Integrity Group Date: June 2008 An Overview of Changes to the Review.

Georgia Association of Homes and Services for Children 2007 Executive Retreat.

THE WYOMING MEDICAID RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM ORIENTATION.

Contract and Policy Changes and General Future Expectations.

Home Town Health Monthly RAC Update November 11, 2015

LPA Training Program. LPA Training Program: Construction/Contract Management Module 2.

PI Audit Design Data mining segregate outliers from utilization, NCCI or double billing Create algorithms based on trend analysis. Jobs and programs in.

Presented by Denise M. Fletcher, Esq. ©2009 Brown & Fortunato, P.C.

CHAPTER EIGHT OVERVIEW OF TAX PROCEDURE. EXPECTED LEARNING OUTCOMES Appreciate and understand: l The voluntary nature of federal tax reporting l The basic.

Medicare Audits and Appeals Scott McBride, Partner Baker & Hostetler Jason Pinkall, Senior Counsel Tenet Healthcare Corporation.

jasa.org Board of Directors Presentation & Training February 24 th, 2016 Corporate Compliance Program.

Department of Health and Mental Hygiene Behavioral Health Services 2013 and Beyond Integrating Mental Health and Addiction Treatment in Maryland Tuerk.

Implementation of the new Home Care Rule: Requirements for Exceptions Process Alison Barkoff Director of Advocacy Bazelon Center for Mental Health Law.

Internal and Governmental Financial Auditing and Operational Auditing

Senate Transportation Committee

Session Three – Post Award Management May 25, 2018

Medicare Recovery Audit Contractors (RACs)

OIG Enforcement Initiatives

Lesson 6 Topic 2 Claims Problems and Appeals

FDA Sentinel Initiative

Living With a Corporate Integrity Agreement

Fy18-19 Compliance Plan Review & Board Member Training

National Healthcare Compliance Audioconference:

Overview of the Office of the Inspector General (OIG) in the Context of Comprehensive Community Services (CCS) Kari Engelke, Assistant Inspector General.

Presentation transcript:

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 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

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

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

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