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Lake County HCPF Grant: Medicaid Fraud Prevention through Community Education

Reduce MA fraud cases in Lake County by 20% through community education and engagement. Review current MA program information with members, increase understanding in the community about MA program policies and reporting obligations, and utilize a Member Experience Advisory Council (MEAC) to improve the member experience. Deliverables include educational materials, tools to measure effectiveness, and ongoing MEAC and possible MA Education Ambassadors.

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Lake County HCPF Grant: Medicaid Fraud Prevention through Community Education

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  1. Lake County HCPF Grant SFY19 Medicaid Fraud Prevention through Community Education

  2. Project Objective Reduce MA fraud cases in Lake County by 20% through community education • Review current MA program information with members • Members assist in creating accurate, helpful information about the MA program • Increase understanding in the community about MA program policies and reporting obligations, with the outcome of MA fraud reduction

  3. Utilization of a Member Experience Advisory Council (MEAC) • MEACs help the State and Counties use a person-centered approach to engage members, their families and caregivers for feedback • Improve the member experience • HCPF provided funding and technical assistance to Lake County in SFY19 for our county-level MEAC

  4. Framing the Issue Our small county economic security unit has become very adept at detecting, investigating and collaborating with our district attorney on MA fraud cases • Since 2014 we have worked 192 MA fraud cases • 27 MA fraud cases referred to the DA totaling $193,141 • 12 MA cases have been successfully charged by our DA totaling $95,185 • 14 open cases currently with the DA totaling $97,955

  5. Lake County Stats Causes of 192 Lake County MA fraud cases by category • 94 (49%) Not reporting all of their income • 68 (35%) Providing false or untrue information • 25 (13%) not reporting all of the people in their household • 5 (3%) Receiving assistance in more than one state

  6. Specific Project Objectives • More people accurately report income • More people accurately report household composition

  7. Deliverables • Educational material designed to reduce fraud • Tools to measure effectiveness (fraud reduction) • Ongoing MEAC and Possible MA Education Ambassadors

  8. Research Question Will more accurate reporting be accomplished through incentive or deterrent?

  9. Lake County Member Experience Advisory Council • 6 meetings between Sept. 2018 – March 2019 • 8 participants (3 attended every meeting) by invitation • Facilitated by Brian Pool of GPS (contracted with HCPF for MEACs) • Lake County provided • Transportation • Child care • Dinner • Spanish Interpreter • Incentives

  10. MEAC Outcomes • 75% attended all 6 Meetings • 50% said “All info available prior to the meeting” • 100% said “Almost Always Collaborative” • 100% said “Almost Always Organized” • 100% said “Almost Always Informational” • 75% said “Almost Always On Topic” • 75% said “Excellent Overall Rating” • 100% said “Extremely likely to recommend friends or colleagues attend” • Several said received helpful information, patience, in a safe setting • Several suggested the meeting be shorter and earlier in the day • 75% said the 2 hour duration of the meetings was “About Right”

  11. MEAC Created a New Document Combined the following existing documents: • Single Purpose Application “What you should know” • MA application • Member Handbook • Fraud referral info from our county website

  12. New Rights & Responsibilities Document The team produced a draft “one-pager” • Key rights and responsibilities that have not been well understood, particularly by the Spanish-speaking members • eligibility criteria • importance of updating income and household members • serious nature of fraud • Translated document into Spanish • Deterrent approach suggested by MEAC to reduce fraud

  13. Lake County MEAC Outcomes • Practiced person-centered approaches with 8 separate members of Health First Colorado over 6 months. • County DHS staff appreciated value of structuring conversations about their services in a neutral setting. • Developed a panel approach to translating complex documents and terminology, including comparing state guides and county documentation. • Agreed to expand the interview process to include a “one-pager” focused on individual members rights and responsibilities, including fraud prevention and reporting. • Lake County is continuing the MEAC process but expanding to include other services such as food and economic assistance.

  14. Recommendations for Maintaininga County MEAC* 1 2 3 Assist with transportation Ensure Members can travel to/from the meeting location, and address the fear that travel reimbursement will impact their income and ability to qualify for services. Balance today’s challenges with tomorrow’s opportunities Have the MEAC focus on improvements that can be rapidly implemented, as well as longer-term opportunities. Clarifying and focusing on opportunities that are under “county” vs. “state” control. Provide information in ways Members request Use platforms (i.e. Internet, mobile phone) Members are already using, and work to make the user-experience easy. Also accommodate for Members who are not technologically savvy or do not have Internet access. 4 5 6 Expand community partnerships Involve local community organizations and businesses as a means of engagement and potential funding to maintain the MEAC long-term. Amplify all staff knowledge and use of person-centered approach Provide training to management and staff in the use of a person-centered approach. This isa critical ingredientto increase positive engagement with Members across services. Consistent, neutral and strong meeting facilitator Use a strong, neutral facilitator who will listen, keep the meeting on track and engage with the right people within in the County to assist in making identified improvements. *The recommendations are not listed in order of importance

  15. HCPF Grant Project Funding • Spent $19,432 • 98% of funds spent on time • Project Supervisor • Project Manager • Project Coordinator • 2 Technical Experts • Finance Manager • Assistant • Underspent – haven’t yet produced educational material

  16. Challenges/Lessons Learned • Consider a project manager for the grant • Took an entire team’s effort • Worth the effort – good community buy in • Members want fraud taken seriously/sense of unfairness about those who access benefits dishonestly

  17. Next Steps • Get educational material finalized and circulated • Print • Video/YouTube in our lobby • Social media • Other avenues? • Finalize measurement tools • Establish member survey for lobby to gauge understanding of program • Evaluate number of fraud cases by category • Continue MEAC and expand into Member Ambassadors roles

  18. SFY20 HCPF Grant • Continue MEAC and grow Ambassador program • Provide community education • Evaluate effectiveness - survey members • Add a project manager!

  19. THANK YOU!Janeen McGee, Director, Lake County DHSJaneen.mcgee@state.co.usGovernment Performance Solutions (GPS), Inc. for Colorado Department of Health Care Policy and FinancingMay 2019 Kate Newberg, Principal Consultantkate@governmentperformance.us Brian Pool, Managing Partner brian@governmentperformance.us

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