The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report in January indicating that Medicaid third party liability (TPL) savings have increased since 2001. Specifically, state efforts have increased cost avoidance and pay-and-chase savings from $34 billion in 2001 to $72 billion in 2011. Many states attributed increased savings [...]
Section 6411 of the Affordable Care Act (ACA) requires states to partner with Medicaid Recovery Audit Contractors (RACs) to identify overpayments and underpayments by the state Medicaid agency; recoup overpayments; create processes for appealing adverse determinations; and coordinate recovery efforts with other entities. As of November, 34 states have awarded Medicaid RAC contracts and 11 [...]
HMS Holdings Corp. — the parent company of HMS, AMG-SIU, IntegriGuard, and other subsidiaries — has been included on InformationWeek 500 for the first time in company history. The annual list — compiled by InformationWeek — recognizes companies that demonstrate innovative uses of business technology. A number of factors contributed to HMS Holdings Corp.’s inclusion on the [...]
Maria Perrin, HMS’s Chief Business Officer, was quoted in an article about the Medicaid Recovery Audit Contractor (RAC) program that was published in a recent edition of the Bloomberg Health Care Fraud Report. The article, “Stakeholders’ First-Year Score Card: Medicaid RAC Program Gets Mixed Reviews,” looks at the impact the Medicaid RAC program had on [...]
In response to the recent formation of The National Fraud Prevention Partnership – a program driven by the White House and top health insurers to fight healthcare fraud – CEO Bill Lucia voiced HMS’s solid support. On August 10, 2012 in a letter to the Partnership, Lucia applauded their mission of fighting fraud by sharing [...]
On Thursday, August 9, 2012 at 2:00pm Eastern, HMS will present a free, one-hour webinar, “RAC and Roll! Sharing Lessons Learned for Effective Medicaid RAC Implementations.” The webinar will explore the status of the Medicaid Recovery Audit Contractor (RAC) program nationwide. The webinar will also outline some of the common roadblocks to implementing a successful [...]
With healthcare reform in the spotlight, this timely op-ed, written by HMS CEO Bill Lucia, appeared in the Richmond Times-Dispatch on Wednesday, June 27, 2012. Recently, the Government Accountability Office (GAO) told Congress that “more needs to be done” to reduce improper payments due to waste, fraud, and abuse in Medicare and Medicaid. That’s an [...]
On September 14, CMS released its long-awaited final rule for the Medicaid Recovery Audit Contractor (RAC) program, which was established by the Affordable Care Act (ACA) in 2010. Under the terms of the ACA, states are required to contract with Medicaid RAC contractors to conduct post payment claim reviews. According to CMS, the agency received [...]
CMS is projecting a 40% increase in Medicaid lives from 2010 to 2015.
CMS projects a 60% increase in total Medicaid spend from 2010 to 2015.
Medicaid covered about 62 million lives and spent about $427 billion dollars in 2010.
Medicaid is expected to grow to over 82 million lives by 2019.
Medicaid spend has grown on average about 8% each year since program inception.
