Foley Partners Daniel Reinberg and Judith Waltz are speaking for the Center for Business Intelligence (CBI) audio conference on “Enforcement Focus on Medicaid: The Medicaid Integrity Program Ramps Up, NY Medicaid Achieves Record Recoveries and Investigations Continue” on March 5, 2009 from 12:00 p.m. – 1:00 p.m. ET.
This session will address the emerging efforts to translate the Medicare program’s recoveries in waste, fraud and abuse to recoveries under the Medicaid program. The federal Medicaid Integrity Program will, however, differ significantly from the federal Medicare Integrity Program, in structure, targets, and methodology. There will be a heightened emphasis on data mining which has significant implications for enforcement activity. Continuing government efforts to improve the quality of health care are also evident in some of the early pronouncements about the Medicaid Integrity Program.
We will also discuss the NY Office of the Medicaid Inspector General as a model for state enforcement activity, which will supplement the federal Medicaid Integrity Program. Within the past year, the OMIG has announced record-breaking recoveries. It has also issued provider compliance program guidance, as well as a detailed work plan which can assist providers in targeting and assessing their own areas of risk.
Medicaid enforcement activities continue, even while compliance efforts are ramping up. The “players” here are both federal and state enforcement agencies, sometimes working together and often across state lines. Recent cases provide guidance for providers as to risk areas and government priorities. We will also discuss self-disclosures in the state arena as a compliance tool.
Medicaid Integrity Program
- Compare/contrast to Medicare Integrity Program
- The Federal/State partnership – difficulties for recoveries
- Overview of structure and efforts
- Increasing focus on data mining
- Incorporating quality into compliance
NY Office of the Medicaid Inspector General as a Model
- Recent recoveries
- Compliance program guidance
- Work plan
- The Federal/State partnership