Florida’s Medicare-Medicaid Program Integrity Review
September 23, 2021 3 to 4 p.m. ET
The Florida Agency on Health Care Administration (AHCA) and its downstream user, HMS, Inc., perform an audit on Medicare and Medicaid claims data for dually eligible beneficiaries as an anti-fraud, waste, and abuse measure. By using the Chronic Conditions Warehouse (CCW) Medicare data files, the state Medicaid agency and HMS are able to compare Medicare payments and deductible/coinsurance amounts to the information submitted to Medicaid for services for this cohort and recoup any identified overpayments made to providers. Florida and HMS will describe the process of obtaining and utilizing the Medicare data for this audit, its return on investment (ROI) results to-date, and its lessons learned and tips for other state Medicaid agencies interested in performing a similar investigation.
A Q&A session will follow the presentation.
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