Unit formed to try to catch Medicaid fraud

by The City Wire staff ([email protected]) 170 views 

The Arkansas Department of Human Services Division of Medical Services (DMS) and the Office of Medicaid Inspector General (OMIG) are proposing to create a Payment Integrity Unit within DHS and a corresponding division within OMIG.

According to a press release from Gov. Asa Hutchinson’s office, the units are being created at the request of the governor.

"Among the seven elements of healthcare reform that I outlined to the legislative task force was improving the integrity of the Medicaid program,” Hutchinson said Thursday (Oct. 15). “This is an important step in that direction. We have an obligation to the taxpayers of Arkansas to make certain public programs like Medicaid are run efficiently and with integrity.”

The unit will focus on prevention and recoveries and use data analytics and industry best practices to find systemic waste. DHS and OMIG will collaborate in policymaking, training, and improving DHS’ claim processing procedures.

DHS will add five positions while OMIG will add two, with all positions funded through expected savings resulting from improved payment integrity. New DHS staff members will include a unit lead, a vendor manager, a clinical expert, and two new analysts. OMIG will add a division manager and support specialist. The positions must be approved by the Legislature.

The press release said Arkansas recovers only $2.1 million, or 0.04% of total Medicaid spending. Other states have higher rates of recovery, including Florida (0.17%), Georgia (0.35%), and Arizona (0.44%).