The Washington State Department of Social and Health Services is collaborating with Ingenix to help fight Medicaid fraud..
Washington’s DSHS was awarded a grant of $5.9 million to cover the initial investment in the contract by the Centers for Medicare and Medicaid Services. The department's five-year, $19 million contract with Ingenix will create a fraud detection and prevention system that would bring together “the tools, resources and comprehensive approach for detection and prevention of fraud, waste and abuse ... (that would establish) a national model for Medicaid payment integrity.”
“Washington has always considered itself on the forefront of efforts to fight Medicaid fraud and abuse,” said Doug Porter, assistant secretary for the health and recovery services administration at Washington's DSHS. “With the current state of the economy, it becomes even more critical to ensure that every dollar spent by Washington taxpayers goes to healthcare services that people need.”
The Washington DSHS provides medical and social services to more than 1 million residents. The overall cost per year to provide medical services reaches around $4 billion annually. With the cost so high, any waste in funds reduces breathing room for the state’s healthcare programs.
Over the first year of the new contract, Washington officials say they expects to regain theirinitial investment and predict an increasing ROI ratio of three-to-one in following years.
This isn’t the first time Washington has collaborated with Eden Prairie, Minn.-based Ingenix. The two have worked for eight years on fighting fraud by deploying detection and prevention tactics. Through the use of collected claims data, rules-based algorithms, peer group models, data analysis tools and provider self-review functionalities, state officials say, Washington’s programs have saved approximately $60 million.
Officials say the new contract will further improve the state’s efforts to increase the integrity of its Medicaid program. The DSHS and Ingenix will focus mainly on prevention by developing a new model that identifies cases where inappropriate payments were made.
“The state of Washington serves as a model for applying innovative technology and analytics to protect the integrity of Medicaid payments,” said Tom McGraw, senior vice president of Ingenix Government Solutions. “Washington’s increased focus on prospectively eliminating errors, fraud, waste and abuse from the system will help to further reduce costs and ensure that Medicaid works better for everyone in the state.”
