Program Integrity for Providers in Managed Care Patrick Piggott, MSW, LCSW, DCSW Chief, Behavioral Health Review Section.

Slides:

Advertisements

Similar presentations

Click to edit Master title style Program Integrity: Fraud & Abuse Glendon Schuster Senior Vice President and Chief Technology Officer Alliance for Health.

Advertisements

The NorthSTAR Service Delivery System Publicly funded, managed care program for 7 counties in the Dallas area that provides mental health and substance.

MH/IDD/SA Providers working in a Medicaid Managed Care Environment

Nevada PASRR Level II Program and Promising Practices

Maryland Choices “One Team – One Mission”. Regional CME Maryland Choices is …  The Northwest Regional Care Management Entity.

JUVENILE JUSTICE TREATMENT CONTINUUM Joining with Youth and Families in Equality, Respect, and Belief in the Potential to Change.

LAKESIDE WELLNESS PROGRAM - PBHCI LEARNING COMMUNITY REGION #3 ORLANDO, FLORIDA, RUTH CRUZ- DIAZ, BSN EXT

Yvonne Lau, MD, PhD, MBHL NIH Extramural Research Integrity Officer OD/OER/OEP National Institutes of Health OER Regional, June 2013.

Office of the Medicaid Inspector General

The importance of a Compliance program is to ensure that our agency meets the highest possible standards for all relevant federal, state and local regulations,

National Public Health Performance Standards Local Assessment Instrument Essential Service:7 Link People to Needed Personal Health Services and Assure.

Sandhills Center 1915 (b)(c) Medicaid Waiver Implementation

NC Department of Health and Human Services DMA Division of Medical Assistance: Integrated Care Workgroup Courtney Cantrell, PhD Assistant Director for.

CONTACT INFORMATION Visit our website – To request any additional information on the PCMH or the Patient Centered Primary Care Collaborative.

COMMUNITY CHILD PROTECTION TEAMS North Carolina Division of Social Services May 2003.

SMHTF: ME Roles & Responsibilities. Purpose LSF Health Systems (LSFHS), in collaboration with its network providers is committed to ensuring coordination.

Medicaid Hospital Utilization Review and DRG Audits: Frequently Asked Questions The Department of Medical Assistance Services Division of Program Integrity.

Care Coordination Overview

Fraud, Waste & Abuse DEFICIT REDUCTION ACT OF 2005 Presented by: MARCH Vision Care, 2013.

NC Department of Health and Human Services DMA Program Integrity: Medicaid Managed Care (1915 b/c Waivers) Patrick O. Piggott, MSW, LCSW, DCSW Chief, Behavioral.

California Bridges to Youth Self-Sufficiency An Overview.

Program Integrity. The Cost of Fraud, Waste, and Abuse Between July 2012 and January 2013, the North Carolina Division of Medical Assistance collected.

PROGRAM INTEGRITY AND PROVIDERS IN MEDICAID MANAGED CARE Julia B. Sinclair, MSW, LCSW Sr. Director, Quality and Integrity Operations Smokey Mountain Center.

Overview Community Care of North Carolina. Our Vision and Key Principles  Develop a better healthcare system for NC starting with public payers  Strong.

Enabling Performance-Based Government Rightsizing New York’s Budget Meeting the Medicaid Challenge Tuesday, December 9, 2008.

Robb Miller, Director Division of Field Operations CMS Medicaid Integrity Group Medicaid Integrity Program AHCA/NCAL 60th Annual Convention October 6,

Darren A. DeWalt, MD, MPH Division of General Internal Medicine Maihan B. Vu, Dr.PH, MPH Center for Health Promotion and Disease Prevention University.

Section 2703: State Option to Provide Health Homes for Enrollees with Chronic Conditions Mike Hall, Director Division of Integrated Health Systems Disabled.

VISIONING SESSION May 29, NWD Planning Grant  One year planning grant, started October 1, 2014; draft plan by September 30, 2015; final plan by.

WV Birth to Three NECTAC Medicaid Conference Call December, 2006 Presented by Pamela Roush, Director WV Birth to Three.

DEPARTMENT OF MANAGEMENT SERVICES OFFICE OF INSPECTOR GENERAL.

Health Budgets & Financial Policy 1. Objectives Introduce the TRICARE Program Integrity (PI) office Explain PI role in DoD Direct Care & Purchased Care.

PCMH Support Teams and the Readiness Evaluation Questionnaire.

Adult Protective Services in Facilities Division of Aging and Adult Services.

Medicaid Program Integrity A View from the States National Medicaid Audioconference Combating Medicaid Fraud and Abuse October 24, 2006 Kathryn Kuhmerker,

ARRA Reporting System September 17, What is Different About ARRA Funds?  Unprecedented levels of transparency, oversight and accountability.

Partners for Children Quality Improvement Health & Welfare Jill Abramson, MD MPH February15, Training.

Department of Health and Mental Hygiene Mental Hygiene Administration Office of Special Needs Populations MHA: Office of Special Needs Populations.

Why CCOs Matter to School Nurses …….and how to become involved.

NC Council of Community Programs Presentation to Stakeholder Engagement Group October 26, 2015.

LEA Conference, October 18, CIWMB Proposed Compliance Strategy Lorraine Van Kekerix Division Chief Compliance Evaluation & Enforcement Division.

SUPPORTED LIVING ARRANGEMENTS (SLA) For Developmental Services Presented by: Kate McCloskey, M.A., C.P.M. Manager of Quality Assurance Sierra Regional.

Medicaid Redesign & Expansion Update Britteny M. Howell Research Analyst Governor’s Council on Disabilities & Special Education.

MCCMH and ARC of Macomb What does your local PIHP provide? How can you make your voice heard? SECTION 298 UPDATE.

jasa.org Board of Directors Presentation & Training February 24 th, 2016 Corporate Compliance Program.

Sustainable Self-Directed Care in Pennsylvania’s Mental Health System Presenter: Kristin Ahrens, Policy Director.

Introduction to NCHS Rob Weinzimer, Special Assistant for Outreach Centers for Disease Control and Prevention National Center for Health Statistics.

Coordinating Medicare Benefit Integrity Adele Culpepper and Amy Miller-Bowman.

J D PEACOCK, II Clerk of the Circuit Court and County Comptroller Okaloosa County, Florida A New Day Continuing the Work of My Predecessor A New Direction.

Association of Government Accountants “Maximizing Government Efficiency Through Technology and Oversight” April 29, 2016 * 9:30 am 1.

2017 LGA MAA/TCM Conference

Refuah Community Health Collaborative (RCHC) PPS

Office of the State Comptroller

Medicare Advantage Plans in Charlotte, Raleigh, Durham NC

North Carolina Medicare Part D

NC CSS Solving the Mystery.

MFP Quality Requirements

SCC Partner Compliance Training Programs

Betty McGrath North Carolina North Carolina Department of Commerce

Refuah Community Health Collaborative (RCHC) PPS

Centennial Care 2.0 MCO Readiness

Adult Protective Services Basic Skills Training

SCC Partner Compliance Training Progams

NC WasteWise Training Workshop

Nassau-Queens PPS Health Home 101

CONSUMERS SERVED PIHP Unduplicated Count of Consumers Served

Fy18-19 Compliance Plan Review & Board Member Training

Medicaid Recipient Audits and More

Organization as an Enabler of High Performance

Office of the Inspector General

Presentation transcript:

Program Integrity for Providers in Managed Care Patrick Piggott, MSW, LCSW, DCSW Chief, Behavioral Health Review Section

OBJECTIVES

Objectives At the completion of this presentation participants will be able to: Describe role DMA Program Integrity (PI) List one responsibility of the Behavioral Health Review Section (BHRS) Identify partnerships in combating fraud, waste, and abuse

Medicaid Landscape Approximately 1.8 million Medicaid recipients Recipients in all 100 North Carolina counties 9 Behavioral Health Prepaid Inpatient Health Plans (PIHP) also known as Local Management Entities –Managed Care Organizations (LME-MCO) Under 3 year old population not covered by managed care

Role of Program Integrity

Ensure compliance, efficiency, and accountability within the N.C. Medicaid Ensure that Medicaid dollars are paid appropriately

Responsibilities of BHRS Perform post-payment reviews of MH/DD/SA providers. Conduct preliminary investigations on all complaints

Responsibilities of BHRS Oversight and Monitoring of 9 PIHP program integrity activities Collaborate and/or coordinate with State agencies

Responsibilities of BHRS All cases of credible allegations of fraud are referred to the Medicaid Investigation Division (MID). PI-MID-PIHP meet quarterly to discuss program integrity-related activities in Managed Care.

Partners Technology Prepayment Review Post-payment Review Investigations and Oversight

Reporting and Analytics

Audits and investigations are driven by data analytics and reporting systems associated with behavioral health providers.

WHAT ARE YOUR QUESTIONS

Contact Patrick Piggott, MSW, LCSW, DCSW Chief, Behavioral Health Review Section NC Division of Medical Assistance Program Integrity Phone: Fax: at Website: