Florida Chief Financial Officer Jeff Atwater’s Medicaid and Public Assistance Fraud Strike Force Reviews State Legislature’s Recent Medicaid Reform, Anti-Fraud Initiatives

 

Florida Chief Financial Officer Jeff Atwater began the Medicaid and Public Assistance Fraud Strike Force (“Strike Force”) meeting yesterday, May 16, 2011, by asking Roberta Bradshaw from the Agency for Health Care Administration (“AHCA”) to provide a brief overview of the Florida Legislature’s recent Medicaid reform efforts, which will usher in a managed care program in Florida. 

In relevant part, Ms. Bradshaw indicated that Florida’s changing to a managed care system could reduce Medicaid fraud, because it most frequently takes place under fee-for-service arraignments.  Managed care plans are also designed to more closely monitor expenses, which will allow early recognition of irregularities. 

Florida’s Medicaid reform legislation also requires those plans participating in the Medicaid program to employ compliance officers and have mechanisms to monitor fraud and abuse. 

Florida Attorney General Pam Bondi asked how the bill would assist the Strike Force in combating fraud.  Ms. Bradshaw responded that, in addition to the inherent advantages in combating fraud with managed care, the increased collection and sharing of data between agencies will undoubtedly help combat fraud. 

CFO Atwater asked whether the federal government would be receptive to providing the waivers necessary to implement the new program.  Ms. Bradshaw responded that AHCA is carefully reviewing the legislation in order to determine what waivers will be necessary, but the federal government has been receptive to Florida’s past waiver applications. 

Kim Berfield, Deputy Secretary for Policy and Advocacy and Director of Women’s Health, Department of Health (“DOH”), then provided a presentation relating to the effectiveness in practitioner licensing in combating fraud.  Ms. Berfield indicated that, over the past several years, the law has been expanded to allow a license to be rejected or revoked if the applicant or practitioner has been found guilty or pled no contest to misdemeanor or felony health care fraud.  She indicated this has greatly increased the DOH’s ability to address fraud by practitioners. 

As of March 24, 2011, the DOH has rejected 208 license applications, year-to-date.  CFO Atwater asked whether the DOH needed any more tools to combat fraud.  Ms. Berfield indicated that the agency needs statutory authority to perform criminal background checks on all applicants for licensure, as well as better communication of arrests of licensees to the DOH. 

Robin Westcott, Strike Force Executive Director, then made a presentation on the Strike Force initiatives.  Ms. Westcott proposed to “map” the Strike Force initiative by using data from individual agencies and aggregate the data in order to track the delivery of Medicaid services from beginning to end through the entire system.  Currently, Medicaid data is spread across agencies and an accurate picture of fraud cannot be developed without looking at all of the data together. 

In order to begin to analyze such data, the Strike Force has retained the ERS Group (“ERS”) to perform economic analysis of all of the data.  ERS will attempt to identify areas of the program that are particularly susceptible to fraud and quantify fraud. 

Ms. Westcott also discussed current barriers to data sharing.  It will be necessary for each agency to identify each Medicaid data set it owns and the rule, policy, or law that allows or prohibits sharing of the data.  Ms. Westcott will provide the Strike Force with a strategic plan for developing recommendations for the Legislature by July 1, 2011. 

David Wilkins, Secretary of the Department of Children and Families (“DCF”) and Strike Force member, presented DCF’s project management initiative.  Secretary Wilkins created a new working group that will monitor eligibility fraud and report directly to the Secretary.  He also reported that the DCF is working to implement the Legislature’s mandate to drug test public assistance recipients by July 1, 2011. 

David Lewis presented the Florida Attorney General’s (“AG”) data mining initiative.  The AG received a waiver from the federal government in order to use federal grant dollars to generally review Medicaid billing for fraud and abuse.  Since October, when the waiver was received, the AG has opened 15 investigations into Medicaid billing practices that would otherwise not been opened. 

Mike Blackburn, Bureau Chief, Medicaid Program Integrity, presented an update on AHCA’s legislative budget request for case management technology and the inter-agency technology working group.  AHCA requested an appropriation from the Legislature to upgrade technology used for Medicaid case tracking. 

After lobbying by the Strike Force, the Legislature appropriated the funds necessary to upgrade technology that will allow for the integration of case management and fraud detection analysis.  This new “neuro-networking” technology will allow for earlier detection of fraud and identification of systems that are particularly susceptible to fraud.  The inter-agency technology working group has been put together in order to identify potential technical problems with data sharing.  The group will develop technology that will allow for more efficient information sharing, which will allow quicker detection and response to fraud. 

The meeting concluded with Ms. Westcott proposing the creation of the four following standing committees:

• Technology Committee
• Grants Committee
  • This committee will initially identify grants the committee is eligible to apply for, and later, award the grants for combating fraud in the State
• Legislative and Policy Committee
  • Will develop and shepherd proposed legislation through the legislative process
• Executive Committee
  • A small subset of the Strike Force that will develop the details of the Strike Force plan and bring the plan to the rest of the Strike Force

To view the complete May 16 meeting agenda, other Strike Force meeting materials, and Strike Force member biographies, click here.

The next Strike Force meeting is tentatively scheduled for August 22, 2011 in Miami. 

 

About CFO Atwater’s Medicaid and Public Assistance Fraud Strike Force

The Medicaid and Public Assistance Fraud Strike Force was created during the 2010 Legislative Session to increase the effectiveness of programs and initiatives that work to prevent, detect and prosecute Medicaid and public assistance fraud. CFO Atwater serves as Chair and Attorney General Bondi serves as Vice Chair of the 11-member Strike Force.

According to CFO Atwater, Florida’s Medicaid program accounts for 25 percent, or approximately $20 billion, of the State’s budget.  The level of fraud is estimated to account for up to 10 percent of the Medicaid budget. State economists indicate that Medicaid is the state’s biggest cost driver, with projected increases possibly exceeding $400 million this year.  From 2005 through 2010, the Public Assistance Fraud Unit referred $18 million in program benefits fraud for prosecution. So far this fiscal year, the unit has received approximately 24,000 referrals for suspected public assistance fraud.

 

 

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