MediStrategy with Kip Piper Episode 09
Fighting Healthcare Fraud and Ensuring Medicaid Program Integrity:
Interview with Bill Lucia, Chairman and CEO of HMS
“Fighting health care fraud is like playing Whac-A-Mole.”
Our nation’s $3.2 trillion healthcare system is a complex beast. To ensure its integrity, we must combat a range of issues – from unintentional errors to criminal activity. Today’s guest is an industry leader in leveraging data analytics and the benefit of a national perspective to identify bad actors and ensure that Medicaid is the ‘payer of last resort.’
Bill Lucia is Chairman and CEO of HMS Holdings, the nation’s largest and most successful company dedicated to providing the broadest range of healthcare cost containment solutions to help purchasers, plans, and at-risk providers improve performance. HMS works with 45 state Medicaid programs, 250 health plans, Medicare, large employers, and provider organizations to help contain costs and protect our nation’s healthcare system from fraud, waste, and abuse.
Today he shares HMS’s holistic approach to safeguarding the integrity of the $590 billion Medicaid program via technology, know-how, and advanced analytics. Listen and learn about HMS’s pioneering work in the areas of fraud detection, overpayment recovery, and coordination of benefits as well as the organization’s policy recommendations for Medicaid reform.
TOPICS COVERED IN THIS EPISODE:
1. The mission of ensuring the integrity of nation’s healthcare system by reducing costs and removing fraud, waste, and abuse.
2. The complex nature of the $590 billion Medicaid system, with over 77 million enrollees.
3. How HMS works to ensure program integrity in Medicaid.
4. How technology, know-how, and analytics are used to identify providers with a propensity for incorrect billing, recognize program rules that cause errors, and anticipate potentially fraudulent activity.
5. How pattern recognition is used to detect inaccuracies and fraud in Medicaid and commercial claims.
6. The significant return on investment (ROI) and multi-billion dollar savings from HMS’ program integrity work.
7. How to make the case for preventative measures.
8. How HMS has built the industry standard in coordination of benefits and Medicaid third party liability.
9. How to leverage advanced analytics, including visual and geospatial analysis to identify fraud and tracking members with high-cost chronic conditions.
10. HMS policy recommendations to Congress and States, including using third parties to ensure Medicaid is ‘payer of last resort,’ incentivizing states to improve oversight, leveraging premium assistance programs more widely, expanding use of data aggregation, and simplifying Medicaid program to reduce errors.
Learn more at HMS at www.HMS.com.
The MediStrategy podcast offers informative interviews with healthcare leaders and insights on hot business and policy issues in Medicare, Medicaid, and health reform. Health executives, policymakers, entrepreneurs, authors, and other influencers share challenges and opportunities in America’s rapidly changing $3.2 trillion health care system.
MediStrategy is hosted by Kip Piper, a top expert on Medicaid, Medicare, and health reform. A prominent consultant, speaker, and author, Kip Piper advises health plans, state Medicaid agencies, hospitals and health systems, provider associations, life sciences companies, and investment firms. Kip is on the web at KipPiper.com and Twitter @KipPiper.