Program Integrity
HMS has been assisting state Medicaid programs with program integrity-related projects for many years, working primarily with Medicaid Program Integrity units and Third Party Liability units.
Through provisions of the Deficit Reduction Act of 2005, CMS was charged with creating and implementing a nationwide Medicaid Integrity Program. This increase in federal scrutiny further amplifies states' responsibilities to conduct their due diligence in order to detect, recover, and prevent inappropriate Medicaid payments.
HMS has a track record of mining large quantities of data to identify erroneous payments or overpayments. Using our warehouse of claims data, HMS can develop and implement large-scale analysis, identification, validation, and recovery projects to assist states in their program integrity efforts.
HMS offers a variety of competencies to assist states with program integrity initiatives:
- A storehouse of historical paid claims data for our current clients
- Data mining and analysis capabilities
- Practical experience with individual states' claim and eligibility data, payment policies and practices, and provider communities
- In-place payment recovery protocols (including billing, provider recoupments, and lockbox arrangements)
- Established relationships with subcontractors expert in financial and clinical audits
- 20+ years of experience in identifying, validating, and recovering overpayments