Medicare-Medicaid Data Match Program

1. 1 Medicare-Medicaid Data Match Program Lourdes Grindal Miller Medi-Medi Program Lead Program Integrity Group Centers for Medicare & Medicaid Services

2. 2 Medicare Medicaid Data Match Program Medi-Medi is a partnership between Medicaid and Medicare that enhances collaboration and reduces fraud, waste, and abuse Medi-Medi is accomplished by matching Medicaid and Medicare data to identify improper billing and utilization patterns. Medi-Medi includes state, regional, and national efforts and requires collaboration among state Medicaid agencies, CMS, and state and federal law enforcement officials.

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4. 4 How Medi-Medi Works CMS funds and oversee the PSC/ZPIC Data warehousing, matching and analysis Medi-Medi Steering Committee Identification and prioritization of potential vulnerabilities Pursuing fraud, waste, and abuse leads generated by the program

5. 5 Implementing DRA CMS is in the process of procuring Zone Program Integrity Contractors (ZPICs), which will consolidate Medicare Parts A, B, C, D, and Medi-Medi Benefit Integrity Activities. Medi-Medi expansion began in fall of 2008. Zone 4 (CO, TX, OK): Health Integrity Zone 7 (FL): SafeGuard Services CMS is considering a regional approach to Medi-Medi.

6. 6 ZPIC Jurisdictions

7. 7 Results Since We Last Met 52 Referrals to Law Enforcement Over $23 Million in Overpayments $4.1 Million in Prepayment Review Denials

8. 8 Examples of 2008-2009 Projects Time Dependent Studies Facet Joint Injections PO Box used for Provider Service Address Ambulance Services Home Health Services

9. 9 Additional Benefits Medi-Medi National Coordinator Improved information sharing through a secure website Catalog of data analysis projects Document sharing Implementation support Cross Training Medicare and Medicaid Data analysis tools One PI Co-location opportunities Enhanced project and case tracking in the Fraud Investigation Database (FID)

10. 10 Joining Medi-Medi If your state is interested in becoming a Medi-Medi state or if you would like more information, please contact Lourdes Grindal Miller.

11. 11 Contact Information Lourdes Grindal Miller Centers for Medicare & Medicaid Services 7500 Security Boulevard Mail Stop: C3-02-16 Baltimore, MD. 21244-1850 Telephone: (410) 786-1022 lourdes.grindalmiller@cms.hhs.gov