Patricia Simino Boyce
New York Quality Improvement Group One of Five Organizations to Receive Inaugural National Contract to “Root Out” Medicaid Fraud
Lake Success, NY, January 24, 2008 – IPRO, a New York-based organization that works to improve and evaluate the quality of the nation’s health care, is one of five organizations nationwide to be awarded an inaugural umbrella contract by the federal Centers for Medicare & Medicaid Services (CMS) under the Medicaid Integrity Program. The Medicaid Integrity Contract (MIC) qualifies IPRO to bid on individual Task Orders issued by CMS for a variety of auditing functions designed to identify and report incidents of fraud, waste and abuse in the Medicaid program.
“Being selected as one of the five organizations to participate under this important new initiative is of major importance to IPRO,” says Harry M. Feder, M.P.A., Senior Vice President & Chief Operating Officer, IPRO. “We have extensive experience and knowledge of the Medicaid program, which was an important factor in CMS awarding us this contract.”
Medicaid, the health insurance program for those who meet certain income criteria, is administered by state governments and funded by both the states and CMS. Until the adoption of the Medicaid Integrity Program, as part of the federal Deficit Reduction Act of 2005, all Medicaid fraud, waste and abuse audits and investigations were handled by state agencies.
IPRO has worked with state governments for more than 20 years to implement Medicaid oversight, and currently conducts more than 120,000 Medicaid utilization and medical necessity reviews each year. IPRO’s audit staff have managed hundreds of Medicaid billing and rate audits, and are experts at identifying aberrant activity. In addition, through CMS’ Hospital Payment Monitoring Program (formerly known as Payment Error Prevention Program) IPRO has worked with New York Prospective Payment System hospitals for six years to identify and address Medicare coding and billing errors.
Section 6034 of the Deficit Reduction Act of 2005, which was signed into law February 2006, established the Medicaid Integrity Program. The program dramatically increased resources available to CMS to combat fraud, waste and abuse, as well as increasing CMS’ responsibility to devise a national strategy to do so. Congress appropriated $5 million in Fiscal Year (FY) 2006; $50 million each year in FY 2007 and 2008; and $75 million for 2009 and each subsequent year.
With more than 20 years of experience in health care quality improvement and evaluation, IPRO holds major contracts with state and federal governments to review the cost and quality of services provided to Medicaid recipients, Medicare beneficiaries, and patients enrolled in managed care organizations and to work with the health care community to improve those services.