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BOAML 2011 Health Care Conference May 11, 2011 Bill Lucia, CEO Walter Hosp, CFO Contact: Christine Saenz csaenz@hms.com 212.857.5986
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What We Do We provide cost containment services for healthcare payors. We help ensure that claims are paid by the responsible party (Coordination of Benefits), and accurately (Program Integrity). As a result, our clients spend more of their healthcare dollars on the people entitled to them. 2
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Who We Serve Federal Programs –Centers for Medicare & Medicaid Services –Veterans Administration –Department of Defense 3 State Programs –Medicaid agencies –CHIPs (Children’s Health Insurance Programs) –Child Support agencies –State Employee Benefit Plans Commercial Programs –Medicaid Managed Care Organizations (MCOs) –Medicare Advantage –Employers
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COMMERCIAL $864 billion 161 million lives Source: CMS, Updated NHE Projections 2009-2019, September 2010; VA.gov; Congressional Budget Office, Oct. 2010 MEDICARE $548 billion 48 million lives MEDICAID $466 billion 62 million lives MILITARY $105 billion 15 million lives UNINSURED 52 million lives Coordination of Benefits 4
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5 How We Grow Capture more lives Ride the Medicaid growth wave Add new products, enter new markets Upsell to existing customers
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Capture More Medicaid Lives Sources: HMS; 2009 CMS Office of the Actuary; Updated NHE Projections September 2010 6
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Ride the Medicaid Growth Wave Actual Projected 1995-2008 data, 2008 CMS Office of the Actuary 2009-2019, CMS, Updated NHE Projections, September 2010 7
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Managed Care Add New Services, Enter New Markets 8 Premium assistance Market Service Real-time COB Pharmacy audits Clinical review Hospital audits CHIP Enrollment integrity CMS Long-term care audits Behavioral health audits Dependent eligibility audits Medicare Advantage Employers Medicare Program Integrity launched 2005 2006 2007 2008 2009 2010 & Beyond Healthcare reform products COORDINATION OF BENEFITS RAC services Prepayment audit solutions Employer plan claim audits
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Upsell to Existing Customers 9 Claim Types Audit Types Markets
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AFFORDABLE CARE ACT
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COMMERCIAL $864 billion 161 million lives Source: CMS, Updated NHE Projections 2009-2019, September 2010; VA.gov; Congressional Budget Office, Oct. 2010 MEDICARE $548 billion 48 million lives MEDICAID $466 billion 62 million lives MILITARY $105 billion 15 million lives UNINSURED 52 million lives Healthcare Financing Today 11
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COMMERCIAL $1,241 billion 165 million lives Source: CMS, Updated NHE Projections 2009-2019, September 2010; VA.gov; Congressional Budget Office, Oct. 2010 MEDICARE $891 billion 61 million lives 12 UNINSURED 24 million lives MEDICAID $896 billion 82 million lives Healthcare Financing 2019 MILITARY $155 billion
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Early adoption of reform Managed care expansion Program compliance ACA Activity 2011-2014 13
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Early Adoption of Reform 14 Medicaid expansion Exchange activity
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Managed Care Expansion 15
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Exchanges Employers –Plan audits –Claim audits –Third-level appeals Managed care program integrity Federal focus on fraud, waste, and abuse Medicaid RAC Program Compliance 16
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Medicaid RAC 17
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INVESTMENT CONSIDERATIONS
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Revenue Diversity and Growth 19 $ Millions
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Key Financial Indicators Rolling Four Quarters 20
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Why HMSY? Proprietary, high growth core business with significant barriers to entry Rapidly growing, early stage program integrity business Market leadership in Medicaid RAC ACA is a growth accelerator Multiple new growth opportunities Strong financial position 21
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22 Safe Harbor Statement Certain statements in this presentation constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995 (the “Reform Act”). Such statements give our expectations or forecasts of future events; they do not relate strictly to historical or current facts. Forward-looking statements can be identified by words such as “anticipates,” “estimates,” “expects,” “projects,” “intends,” “plans,” “believes,” “will,” “target,” “seeks,” “forecast” and similar expressions. In particular, these include statements relating to future actions, business plans, objects and prospects, and future operating or financial performance. Forward-looking statements are based on our current expectations and assumptions regarding our business, the economy and other future conditions. Should known or unknown risks or uncertainties materialize, or should underlying assumptions prove inaccurate, actual results could differ materially from past results and those anticipated, estimated or projected. We caution you therefore against relying on any of these forward-looking statements. Factors that could cause or contribute to such differences include, but are not limited to: the development by competitors of new or superior services or products or the entry into the market of new competitors; all the risks inherent in the development, introduction, and implementation of new products and services; the loss of a major customer, customer dissatisfaction or early termination of customer contracts triggering significant costs or liabilities; variations in our results of operations; negative results of government reviews, audits or investigations to verify our compliance with contracts and applicable laws and regulations; changing conditions in the healthcare environment, particularly as they relate to current healthcare reform initiatives; government regulatory, political and budgetary pressures that could affect the procurement practices and operations of healthcare organizations, reducing the demand for our services; and, our failure to comply with laws and regulations governing health data or to protect such data from theft and misuse. A further description of risks, uncertainties, and other matters can be found in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2010, a copy of which may be obtained from the Company’s website at www.hms.com under the “Investor Relations” tab. Any forward-looking statements made by us in this Presentation speak only as of the date of this Presentation. Factors or events that could cause actual results to differ may emerge from time to time and it is not possible for us to predict all of them. We undertake no obligation to publicly update forward-looking statements, whether as a result of new information, future events or otherwise, except as may be required by law.
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23 NASDAQ: HMSY
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