State of Washington Awards Program Integrity Contract to Ingenix
State Bolsters Fight Against Medicaid Fraud, Waste and Abuse to Protect Taxpayer Dollars Expects to Recoup Contract Expenditures Several Times Over
OLYMPIA, Wash., and EDEN PRAIRIE, Minn. (July 28, 2009) –
The Washington State Department of Social and Health Services (DSHS) has awarded a $19 million, five-year contract to fight and prevent Medicaid fraud, waste and abuse to Ingenix, a leading information, technology and consulting services company.
Washington’s initial investment in the contract is funded by a $5.9 million Medicaid Transformation Grant awarded by the federal Centers for Medicare and Medicaid Services (CMS). The Washington DSHS grant application to CMS outlined the goal of creating a second-generation fraud and abuse detection system that would bring together “the tools, resources, and comprehensive approach for detection and prevention of fraud, waste and abuse…[that would establish] a national model for Medicaid payment integrity.” Over the course of the new contract with Ingenix, Washington expects to recover contract costs in the first year of operations, with an increasing return-on-investment ratio over the life of the contract, expected to be no less than three-to-one.
The new contract builds on work Washington has undertaken with Ingenix over the past eight years to achieve breakthrough financial results in Medicaid Program Integrity, or the ability to eliminate fraud, waste and abuse from Medicaid programs. During that time, the State has realized more than $60 million in cost savings, most in actual dollars recovered, not merely dollars identified as improperly expended. To achieve this, Washington’s DSHS worked with Ingenix and other subject matter experts to mine health care claims data. Using Ingenix rules-based algorithms, peer group models, data analysis tools, and provider self-review functionalities, DSHS was able to identify, prevent, and/or recover inappropriate payments to health care providers.
The new contract with Ingenix will enhance the State’s Medicaid Program Integrity efforts, mainly by helping DSHS focus more effectively on preventing fraud, errors and abuse before they occur. The new contract enables the DSHS partnership with Ingenix to evolve from a “provider collection” program integrity model, in which fraud and abuse is mainly identified retrospectively, to a prospective program integrity model with emphasis on preventing errors, fraud, waste and abuse. To facilitate the shift, DSHS selected Ingenix’s products, services and tools; clinical and analytical expertise; project management and consulting capacity; and subject matter expertise in areas such as managed care, and fraud, waste, and abuse detection techniques.
“Washington has always considered itself on the forefront of efforts to fight Medicaid fraud and abuse,” said Doug Porter, Assistant Secretary for the Health and Recovery Services Administration in DSHS. “With the current state of the economy, it becomes even more critical to ensure that every dollar spent by Washington taxpayers goes to health care services that people need.”
Said Tom McGraw, senior vice president of Ingenix Government Solutions, “The State of Washington serves as a model for applying innovative technology and analytics to protect the integrity of Medicaid payments. Washington’s increased focus on prospectively eliminating errors, fraud, waste and abuse from the system will help to further reduce costs and ensure that Medicaid works better for everyone in the State. We are grateful to serve as a trusted partner to the State as they work to achieve the next level of program integrity.”
About Washington DSHS
Washington’s Department of Social and Health Services (DSHS) provides medical and social services to over one million low-income residents – paying $4 billion annually to more than 40,000 medical providers and $1.6 billion annually to more than 80,000 social service providers. Washington’s Medicaid Program Integrity efforts cover Medicaid and social service payments for all of DSHS. Program Integrity Staff are consolidated within the Health and Recovery Services Administration’s (HRSA) Division of Systems and Monitoring (DSM). Program Integrity efforts are led by the Payment Review Program (PRP) and the Office of Payment Review and Audit (OPRA). The HRSA PRP is nationally recognized for its progressive and innovative approach to the detection and prevention of Medicaid fraud, waste and abuse through the use of sophisticated data mining processes and analysis.
About Ingenix
Ingenix, a UnitedHealth Group company (NYSE: UNH), transforms organizations and improves health care through information and technology. Organizations rely on its innovative products, services and consulting to improve the delivery and operations of their business. More information about Ingenix can be obtained at www.ingenix.com.
Ingenix’s Government Services division is the nation’s leading business intelligence and program integrity solutions provider for government health and human services agencies. Ingenix believes that health information technology is an essential component in efforts to reduce costs and improve quality in Medicaid and Medicare systems. Ingenix solutions help manage one of every three Medicaid dollars nationally, and more than 25 percent of total Medicaid beneficiaries. We serve in 27 states, including six of the largest Medicaid programs by budget.
ABOUT CMS and MTG grants
The Centers for Medicare & Medicaid Services (CMS) is the US federal agency which administers Medicare, Medicaid, and the State Children’s Health Insurance Program. Congress directed CMS to fund Medicaid Transformation Grants (MTGs) for the purpose of encouraging states to “adopt innovative methods to improve the effectiveness and efficiency in providing Medicaid.” The implementation of MTGs provides new opportunities for States to work with the Federal Government to build on effective reforms to slow spending growth while providing needed and quality healthcare coverage.
Source: Ingenix
