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Consortium pitches $685,000 pilot to analyze Medicaid claims for fraud, waste and abuse
Summary
A representative of the American Research and Policy Institute requested $685,000 as a one-year pilot (90/10 match) to deploy analytics that identify potential Medicaid fraud, waste and abuse and produce provider-level breakdowns that the Department of Community Health could use for program integrity and rate-setting.
Ray Williams presented on behalf of the American Research and Policy Institute (ARPI), describing a proposal to pilot provider-level analytics to detect potential Medicaid fraud, waste and abuse.
What was proposed: Williams said ARPI is a consortium of health economists, physicians and analysts with experience working with state governments, CMS and commercial payers. He said the group has analyzed datasets covering more than 100,000,000 lives and about $15,000,000,000 in claims. ARPI proposed a one-year pilot for $685,000 with a 90/10 federal/state match to provide data-driven review capabilities and provider-level analytics for the Department of Community Health.
Why it matters: Williams said the analytics would provide granularity DCH has not had previously and that results could support program-integrity efforts and inform rate-setting when populations change (for example, if ABD populations are added to managed-care organizations in coming years).
Ending: The committee received the pitch during public comment and did not vote; Williams said he would follow up with DCH on the proposal.
