The Office of the Medicaid Inspector General Combating Fraud, Waste, and Abuse in the Arkansas Medicaid Program

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The Office of the Medicaid Inspector General Combating Fraud, Waste, and Abuse in the Arkansas Medicaid Program Bart Dickinson, Chief Counsel Office of the Medicaid Inspector General The Office of

1 The Office of the Medicaid Inspector General Combating Fraud, Waste, and Abuse in the Arkansas Medicaid Program Bart Dickinson, Chief Counsel Office of the Medicaid Inspector General The Office of Medicaid Inspector General shall prevent, detect, and investigate fraud, and abuse within the medical assistance program. - Ark. Code Ann The Office of the Medicaid Inspector General fulfills the federal program integrity requirement to ensure compliance, efficiency, and accountability within the Medicaid program by detecting and preventing fraud, waste, and abuse under - 42 CFR 455 et al. 1

expended payments; Report fraud and abuse to appropriate law

2 OMIG focus Verify Medicaid services and claims were furnished and properly billed for eligible beneficiaries; Recover improperly expended payments; Report fraud and abuse to appropriate law enforcement; Recommend and implement changes to the Medicaid program. Who is HFMA? 2

OMIG Agency Work plan Audit and Review Medicaid Providers Federal Program Integrity requirements Investigate, Suspend, and Exclude Providers Recommend

3 OMIG Agency Work plan Audit and Review Medicaid Providers Federal Program Integrity requirements Investigate, Suspend, and Exclude Providers Recommend and Implement reform Develop Initiatives to curb Fraud, Waste, and Abuse in Medicaid programs Educate Medicaid Providers Data Analysis and Audit Selection 3

4 Selecting Medicaid Providers for Audit and Review Highest Billers = Field Audit High Billers = Desk Audit Mid Level Billers = Self Audit Req. Low Level Billers = Awareness Let. Program Review / Change 4

5 $4,000, Year Analysis of Medicaid Recoupments and Claims $3,500, $3,000, $2,500, $2,000, $1,500, $1,000, $1.1 million $2.1 million $3 million $2.7 million $3.8 million $500, $0.00 FY Division Medical Services FY 2014 FY 2015 FY2016 FY OMIG Initiatives Behavioral Health (Group Psychotherapy) OMIG recommendations reduction to 4 daily units ( 1 hour) and 100 units per year passed work with DBHS/Beacon on Authorization for 911 and child population $14.5M reduction in Group Psych since October 2016 implementation Rate reduction from $13.80/unit to $10.00 withdrawn as compromise for BH Transformation reduction could have been much higher. Have requested DHS review whether this reduction could be revisited. Personal Care and Home Health Reform August 3, 2016 OMIG asked DHS & DMS to join in reform initiative and to assign all workers ID # Reform will help protect vulnerable population and reduce fraud, waste, and abuse. Other states like Alaska and Minnesota have realized significant savings to Medicaid programs. Recommendations to DHS/DMS for reform that could save millions each year Recommendations could provider better oversight, treatment, care, and protection 5

6 2017 OMIG Initiatives Vision recommendations and reform Dental reviews and education Pharmacy recoveries and reform Hospital In-patient reviews School based therapy initiatives Dual Eligible Recipient recoveries and reviews Emergency and Non-Emergency transportation 2017 OMIG Initiatives Behavioral Health Reform Transportation Vision, Dental & Pharmacy In-patient Hospital Stays School-Based Therapy Dual Eligible Recipients Payments Personal Care and Home Health Reform Medicaid Expansion Enrollment (Arkansas Works FFM) Total Cost Savings Impact = $30 million 6

OMIG Recoupments/Reversals/Claims and Collections CLAIMS % Increase Collections % increase TOTALS: $3,791,902.58 28.

7 OMIG Recoupments/Reversals/Claims and Collections CLAIMS % Increase Collections % increase TOTALS: $3,791, % $2,815, % Agency spend Total Agency Budget Total Agency expenditures $2.68 million $2.35 million Turn Back $330,000 (12.3% 7

8 Extrapolation The department shall not rely on the denial of one claim as the sole basis for the denial of a subsequent claim and shall establish that the subsequent claim is deficient. Ark. Code Ann (f) 8

9 New Mexico Medicaid Auditing Fiasco OMIG Case Study in Fraud 9

10 Data Analytics leads to Investigations As a provider, you are required to retain and make records available... Please compile and provide legible copies of all the original patient records... 10

11 Data Analytics for Dodd Date trends showed continued and excessive billing even with fewer recipients being provided services Billing Cycle Patients Payments Avg. $$ per Patient Jan $ 24, $ 1, Mar $ 20, $ 1, May $ 18, $ 1, Jul $ 27, $ 1, Sep $ 40, $ 1, Nov $ 34, $ 1, Jan $ 21, $ 1, Mar $ 24, $ 2,

12 What is your duty as an Accountant? Duty Ethical vs. Legal? Has your client/company evaded taxes? Is your client/company attempting to evade taxes? What do you do? / Who do you contact? What is your exposure? CPA Indictment 12

13 Potential Criminal Exposure The IRS also accepts complaints about tax return preparers who have committed fraud, and anyone with an issue may submit a complaint using Form 14157, Complaint: Tax Return Preparer. In-house accountants who cook the books or purposefully include erroneous data in their company's tax returns or accounting documents are responsible for misconduct and may even be criminally liable. AccountantResponsibility erms/a/accountant-esponsibility.asp#ixzz4oiyevki7 13

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15 Medicaid Fraud Self Report 15

16 Medicaid Fraud Self Report OMIG Website 16

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