MEDICAID INTEGRITY PROGRAM Charles Cataline Senior Director, Health Policy Ohio Hospital Association

Jan 25, 2013

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Medicaid Integrity Program . Three-Year Rollout (Ordered in DRA '05) UnderwayCMS Region V Rollout Scheduled for Fall 2009Not RAC: Rules, Players, Look-Back

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MEDICAID INTEGRITY PROGRAM Charles Cataline Senior Director, Health Policy Ohio Hospital Association

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ohio hospital association and caresource collaboration

Our Heartbeat . HeartbeatMaking a difference in the lives of underserved people by improving their health careVision CareSource will be an innovative national leader in the management of quality public-sector health care programs. 2. Goal: Providers as Partners. By the Numbers. Operations: Ohio And MichiganEmployees: 920 EmployeesMembership: 850,000 12 Million Medical Claims Processed97.0% Of Claims Paid Within 30 DaysMajority, Slightly More Than 2 WeeksEDI Rate 82%-National Rate 215

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Hospital Care Assurance Program Update Ohio Hospital Association Annual Meeting June 14, 2011

. Hospital AssessmentsFederal Funds Total $198.7 M $346.4 M $545.1 M2011 program $23 million smaller than 2010 program;Loss of ARRA stimulus support Assessment (preliminary) 0.8638643% on costs up to $216,372,500 and 0.588007% on costs above; Distribution policy unchanged from 2010Proportional reductions to all funding potsHospital closure redistributionJFS expected to file rules soon/begin state process.

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Ohio School Based Health Care Association

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Medicaid Integrity Program State PI Reviews CMS Medicaid Integrity Group Division of Field Operations

Deficit Reduction Act of 2005: MIP Statutory Requirements. Created Medicaid Integrity Program (MIP)Contracts for Claims Review, Audits, Overpayment Identification

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Medicaid Program Integrity A View from the States. National Medicaid Audioconference Combating Medicaid Fraud and Abuse October 24, 2006 Kathryn Kuhmerker, President THE KUHMERKER CONSULTING GROUP, LLC kuhmerker@nycap.rr.com. Outline of Presentation. What is Medicaid program integrity?

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CMS Medicaid Integrity Program

CMS Medicaid Integrity Program. Agenda. Overview of Medicaid Integrity Program Medicaid Integrity Group Task Orders Program Specifics Questions/Discussion. Overview of Medicaid Integrity Program .

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Ohio Health Care Association Annual Convention

Ohio Health Care Association Annual Convention. John L. Martin, Director May 1, 2012. Increasing the opportunity f or individuals with disabilities to control and make choices about their lives. That is the basic tenet of what it means to be human.

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Michigan health & hospital association

Michigan health & hospital association. Medicare Wage Index Project FFY 2015 Data FFY 2011 and Subsequent Years Data. October 9, 2013. Presenter: Dale Baker Baker Healthcare Consulting, Inc . Dial in Number:1-888-809-4012 Access Code: 7038619

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Ohio Medicaid Health Home Program

Ohio Medicaid Health Home Program. Webinar: Using the MITS Web Portal to support Health Homes Jan 8, 2013. Agenda. Basic Information – Using MITS Web Portal System Registration System Navigation New Health Home Features: HH Client Enrollment HH Client Search Functions

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Washington State Hospital Association Health Information Program

Hospital Services Are Changing. Washington state is one of the leaders in efficient use of services. Year-to-year differences in inpatient use patterns are small. Larger shifts are seen over time, as patient populations and medical technology change.

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Medicaid Integrity Program

Medicaid Integrity Program. … and other issues. The Medicaid Integrity Program. Managed by CMS – not OIG The Medicaid Integrity Group David Frank, Director – former prosecutor Support not supplant state efforts – however, is expected to put a lot of pressure on states to perform

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Ohio Medicaid Expansion

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Charles Cataline Vice President, Health Economics and Policy Ohio Hospital Association

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Healthcare Financial Management Association Northeast Ohio Chapter OHA Update Charles Cataline

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Health Policy Series: Medicaid

Health Policy Series: Medicaid. Nina Owcharenko Director Center for Health Policy Studies The Heritage Foundation October 11, 2011. Enrollment and Spending. Over 60 million on Medicaid (2010) Up from 35 million in 2000 (Source: CMS Actuary) $404.9 billion total spending (FY 2010 )

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Program Integrity and Providers in Medicaid Managed Care

Program Integrity and Providers in Medicaid Managed Care. Julia B. Sinclair, MSW, LCSW Sr. Director, Quality and Integrity Operations Smokey Mountain Center Amanda Maultsby Willett, MS, CHC Regulatory Compliance Manager East Carolina Behavioral Health. Training Objectives.

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Washington State Hospital Association Health Information Program

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Ohio School Based Health Care Association

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Ohio AmeriCorps Winter Program Director Meeting

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Ohio Medicaid

Ohio Medicaid. March 13, 2019. Why We Care. Ohio’s Medicaid Program is the : Largest health insurer in the state Largest payer of long-term care in the state Largest state program in Ohio Sixth largest Medicaid program in the nation. Historic Medicaid Spending.

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MEDICAID INTEGRITY PROGRAM Charles Cataline Senior Director, Health Policy Ohio Hospital Association

MEDICAID INTEGRITY PROGRAM Charles Cataline Senior Director, Health Policy Ohio Hospital Association

Presentation Transcript

ohio hospital association and caresource collaboration

Hospital Care Assurance Program Update Ohio Hospital Association Annual Meeting June 14, 2011

Ohio School Based Health Care Association

Medicaid Integrity Program

Medicaid Integrity Program State PI Reviews CMS Medicaid Integrity Group Division of Field Operations

Program Integrity in Medicare and Medicaid

Medicaid Program Integrity A View from the States

CMS Medicaid Integrity Program

Ohio Health Care Association Annual Convention

Michigan health &amp; hospital association

Ohio Medicaid Health Home Program

Washington State Hospital Association Health Information Program

Medicaid Integrity Program

Ohio Medicaid Expansion

Charles Cataline Vice President, Health Economics and Policy Ohio Hospital Association

Healthcare Financial Management Association Northeast Ohio Chapter OHA Update Charles Cataline

Health Policy Series: Medicaid

Program Integrity and Providers in Medicaid Managed Care

Washington State Hospital Association Health Information Program

Ohio School Based Health Care Association

Ohio AmeriCorps Winter Program Director Meeting

Ohio Medicaid

Michigan health & hospital association