Encouraging Innovation to Fight Medicaid Fraud

By Julie Boughn 

The Centers for Medicare & Medicaid Services (CMS) is committed to fighting Medicaid fraud, which diverts funds from needed medical care for the most vulnerable Americans.  That’s why we’re announcing a challenge – the Provider Screening Innovator Challenge – to develop software tools that will help stop fraudsters from entering the Medicaid program under the pretense of serving patients.

The Provider Screening Innovator Challenge encourages private sector competition to develop new software that can screen potential Medicaid providers and keep bad actors from ever getting into the program.  Through a series of contests over the next 8 to 9 months, expert software developers will work to create software products, and the best ideas will be awarded prize money.   A total of $600,000 is available for prizes, funded by the Partnership Fund for Program Integrity Innovation, a program within the Office of Management and Budget.

The new software products will include enhanced screening data, such as the results of site visits, criminal background checks, and identity verification.  Fraudsters who try repeatedly to enter Medicaid by altering their applications with a slight change will also be blocked.  The software will also capture licensing information and financial data to spot and stop risky providers.

CMS is conducting this Challenge in partnership with the National Aeronautics and Space Administration, Harvard Business School, the State of Minnesota, and TopCoder (an online community of software engineers, computer scientists, and digital creators).

We eagerly await the ideas and products offered through the TopCoder community to help keep bad actors out of State Medicaid programs.  CMS will also be working with additional States to help us in finalizing software requirements as well as piloting the new software.

The first contest begins May 30th at 6:00 p.m. Eastern Time. Registration information is available at the Center of Excellence for Collaborative Innovation Challenge portal: http://community.topcoder.com/coeci/.

Further information about the Provider Screening Innovator Challenge is available at www.medicaid.gov.

Ready for the 2012 SHIP Conference?

By Vicki Dufrene, Louisiana SHIP Director

Late spring means the annual SHIP conference is on its way—the 18th Annual SHIP Director’s Conference will be held June 4—7 in Atlanta.

It’s hard for me to believe that almost a year has passed since I found myself surrounded by dear friends and colleagues trying to absorb as much information as possible to help us better serve the aging network in our respective states.

This year’s theme is “Yesterday, Today and Tomorrow…Navigating Healthcare Changes Together.”  Health reform is on the horizon and this conference will give us insight and information to guide our staff, partners and volunteers through the maze of new challenges that will face us as we prepare for 2014.

It’s also a great opportunity to network, share best practices, talk about lessons learned, and learn about new Medicare programs and initiatives.

I’m looking forward to seeing my peers, friends and confidants, as they have proven to be a valuable asset—and even a source of comfort—over the past year.  At last year’s conference, I received a call from my office advising that two of my co-workers were killed in the line of duty.  As my staff and I gathered together to understand what was being told to us, the SHIP network extended their hearts, arms and prayers to comfort us when we needed it the most.  At this conference I hope to thank each one personally for their loving support and encouragement.

The need for a “Strong Start” in life

By Marilyn Tavenner, Acting Administrator for the Centers for Medicare & Medicaid Services

Like most of us, you probably know someone who had a baby born prematurely. These children are at greater risk for complications at birth as well as for developmental and health problems that can impact their quality of life as adults. Premature births are also an economic issue– preterm and premature births cost our country and hard-working families at least an estimated $26 billion each year.

Recently, a report from the World Health Organization, the March of Dimes, Save the Children, and the Partnership for Maternal, Newborn and Child Health found that more than half a million babies in the United States are born preterm each year. That’s more than 130 other countries– almost tying us with Somalia, Thailand, and Turkey. Moreover, early elective deliveries still account for 10-15% of all deliveries in the United States. While the United States excels at treating premature and preterm newborns, it would be better if more of our babies were born at full term.

To safely reduce preterm and premature births, the U.S. Department of Health and Human Services launched the Strong Start initiative earlier this year.  Strong Start builds on the work of American College of Obstetricians, the March of Dimes, and many others to reduce early elective deliveries.  Strong Start also involves change in prenatal care delivery to reduce premature and preterm births and improve outcomes for high-risk pregnant Medicaid beneficiaries and their newborns.

Decreasing early deliveries means:

  • More mothers get safe, evidence-based care and infants improve their chances for good physical and developmental health.
  • Public and private payers may see lower costs because providers are performing fewer caesarian sections for failed inductions, there are fewer neonatal intensive care unit admissions, and there are fewer associated complications for the newborns.

As a mother, I know there’s nothing more important for a child than getting off to a healthy start.  With the right resources and tools, we can make sure mothers and children around the country get the best care possible to give children a strong start in life.

Let’s get mothers and newborns off to a strong start.  Learn more about Strong Start and what you can do to reduce the rate of premature and preterm births.

Information on Implementation of the Physician Payments Sunshine Act

On December 19, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule implementing the Physician Payments Sunshine Act, which was included as section 6002 of the Affordable Care Act of 2010.  This provision will provide important transparency in requiring reporting of payments or gifts to physicians, and physician ownership and investment interests.  During the 60 day comment period, CMS received over 300 comments from a wide range of stakeholders.

CMS is committed to addressing the valuable input received during the comment period, and to ensuring the accuracy of the data collected.  In order to provide time for organizations to prepare for data submission and to sufficiently address the important input we received during the rulemaking process, CMS will not require data collection by applicable manufacturers and applicable group purchasing organizations before January 1, 2013.

CMS intends to release the final rule later this year.  This timing will provide CMS with additional time to address operational and implementation issues in a thoughtful manner, and the ability to ensure the accuracy of the data that is collected.

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