Showing posts with label Ingenix. Show all posts
Showing posts with label Ingenix. Show all posts

Friday, October 22, 2010

Ingenix Works With Medicaid To End Fraud

Ingneix has also contracted with Michigan to function as a "watchdog" over its child welfare services.

How effective they have been has yet to be proven.

It can only be hoped that the state will be overseeing it child welfare programming, as it is, in a large part, funded through Medicaid and that cash cow keeps getting fatter and fatter...

Ky. hires company to serve as Medicaid watchdog

Associated Press - October 22, 2010 4:04 AM ET
FRANKFORT, Ky. (AP) - Kentucky's Medicaid program has hired a watchdog.
Gov. Steve Beshear said the state has contracted with a Minnesota-based company to review medical claims in an effort to detect waste, fraud and abuse.
A statement from Beshear's office says the company, Ingenix, also will make recommendations for improvements and keep the Department for Medicaid Services updated on changes in federal regulations.
The company will be paid according to the amount of Medicaid overpayments it recovers. Under the 3-year contract, Ingenix will receive 12.5% of the amount it recoups. State and federal governments will divide the rest.
The statement said officials estimate the new system will identify $27 million per year in excess spending.

Thursday, February 25, 2010

Michigan Gives

The Michigan Department of Community Health (DCH) has initiated Medicaid policy proposal that will impact the way the state deals with the need for services.

What makes this policy proposal so progressive is that it will expand the role of Medicaid funding to provide proactive services to new mothers.

The focus is on home visits by physicians prior to the birth and immediately after to "prescribe" needed services to new mothers. This will include transportation to medical appointments and housing assistance.

In the event further assistance is necessary, the physicians will work with Child Protective Services to provide further services.

Instead of relying upon the current state policies of taking children into the child welfare system in order to create eligibility of services, this policy will eliminate that criterion.

My only concerns would be in the area of Receipient Rights. DCH has in place, a formal grievance policy, but I would like to see this new policy proposal to reflect the mandatory informing of each client.

This would also demand further policy changes within the Department of Human Services (DHS) and the Department of Attorney General for uniform implementation to address potential fraud, waste and abuse. An example would be the mandatory reporting of all violations of law to the Attorney General Medicaid Fraud Control Unit.

The policy will even empower the people to provide the transparency and accountability by encouraging program oversight and report fraud, waste and abuse.

What excites me the most is that these new policies expand the potential usage of Targeted Case Management and may be viewed as job creation. By this I mean Michigan, being a service-orientated state, will evolve a new future industry by investing in its people. Jobs in the areas of education, health care, home repair and transportation would not be through the traditional corporate structure, but may be the beginning of an entrepreneurial trend of allowing home businesses to contract with the state. This will be the new privatization.

Since Ingenix has the contract with DHS to maintain a database for services, it must cooperate with DCH, the Auditor General and the Attorney General for the DCH policy to have maximum effect.

Who knows, if Michigan can execute this and establish health information technology, the state may just be able to adjust its Federal Funding Participation rate.

Now, dismantle Michigan Children's Institute (MCI) as it is contradictory to this policy initiative. 

MCI Superintendent Bill Johnson bases his decisions to grant or withhold grant to adoption, including the power to make or change the placement of a child, based on the needs this policy addresses.  Even though this only affects a small portion of the state population, it is still an antiquated belief that poverty is considered as abuse and neglect. 

This policy allows, the state to give to the child, not to take the child.

Michigan Medicaid Policy Proposal 2010

Public comments are encouraged. Comments on this proposed policy are due March 26, 2010.

Comments may be forwarded to Judith Tubbs at tubbsj@michigan.gov or to the address noted on the attached transmittal sheet.

Wednesday, January 13, 2010

Michigan Adopts Transparency and Accountability

It is always easy to stand up and complain, but it is more honorable to create and present solutions. Michigan has stood up to take a leadership role in transparency and accountability in child welfare through information technology.

This pilot program is only the first step, breaking grounds to erect a national edifice to end fraud, waste and abuse in child welfare.

I cannot hail the work of the Michigan State Court Administrative Offices, Department of Human Services, and Department of Community Health enough on this initiative.

This centralized database has so many future implications and applications, the most important being the dismantling of the archaic Michigan Children's Institute, because I am sure the Superintendent would not grant the state consent to this adoption. Let's come together as a nation and help Michigan raise its two newly adopted children, Transparency and Accountability.

Congratulations, Michigan, Welcome to the 21st Century! Bravissimo!! And thank you, Ingenix!!!

Michigan State Government Uses Technology to Enhance Child Protection Services


LANSING, Mich. & EDEN PRAIRIE, Minn.--(BUSINESS WIRE)--
Two branches of Michigan state government are sharing information and using advanced analytics to better protect and care for children in a program slated to expand this year.
The State Court Administrative Office (SCAO) and the Michigan Department of Human Services (MDHS) have piloted a program in Genesee, Saginaw and Livingston counties aimed at measuring and improving performance and accountability in cases involving child abuse, neglect, foster care, adoption, and legal guardianship among the 16,000 children enrolled in child welfare services in Michigan. The program will expand to include additional performance measures this year.
The goal is to improve children’s safety, health and living situation stability – known as “permanency” – and to improve compliance with due process and timeliness in the court’s disposition of cases.
Both agencies are working in partnership with Ingenix, a leading health information, technology and consulting company, which is developing the analytics and performance measurements for the program. SCAO and MDHS data are included in Michigan’s statewide data warehouse – one of the most comprehensive in the nation – which serves as the informational and analytical backbone for the project.
“This collaboration with MDHS and the use of advanced technologies will help us achieve our ultimate goal of improving the lives of Michigan’s children,” said State Court Administrator Carl Gromek. “Our goal is to do a better job protecting the children in our care, who may be in an abusive or neglectful environment, by measuring our performance and prioritizing the areas that need improvement most.”
“We’re pleased to work with SCAO on this ambitious effort,” said DHS Director Ismael Ahmed. “It’s an excellent example of working not only across agencies, but across branches of government, to achieve a worthwhile goal – in this case, doing everything we can to protect children.”
The specific performance measurements, 62 in all, are based on recommendations in a white paper titled Building a Better Court: Measuring and Improving Court Performance and Judicial Workload in Child Abuse and Neglect Cases, published jointly by the American Bar Association’s Center of Children and the Law, the National Center for State Courts, and the National Council of Juvenile and Family Court Judges.
The measurements are divided into five areas:
  • Safety: To ensure that children are safe from abuse and neglect while under court jurisdiction
  • Permanency: To ensure that children have stability and permanency in their living situations
  • Due Process: To ensure that cases are dealt with impartially and based on evidence before the court
  • Timeliness: To enhance the “expedition to permanency” by minimizing the time from filing of the petition to take jurisdiction over the child to permanency
  • Well-being: To examine and address factors other than safety and permanency that relate to a child’s future welfare. There are specific measures within this area that focus on physical health, mental health, and special education needs.
The Michigan program has been in the pilot stage for the past year. So far nine of the 62 measures for Genesee, Saginaw and Livingston counties have been completed. The nine measures, compiled from data already stored on the data warehouse, will be expanded during 2010. SCAO’s Child Welfare Services (CWS) division was awarded a federal Court Improvement Program (CIP) grant to help fund the project.
Measurements in the five areas provide officials with the opportunity to improve performance in very specific ways. For example, the “Timeliness” category measurements include: “Number of days from initial petition to adjudication” of court cases, and “number of hours from initial complaint intake to the commencement of the investigation.” The “Permanency” measurements include: “number of placement changes each child has had during each foster care episode;” and “number of children who are dismissed from court jurisdiction at age 18 and over and have two or more of the following within 6 months of emancipation,” with the choices that follow including high school diploma/GED, steady employment, housing, entering college or trade-school, and several others. “Well-being” measurements include “percentage of cases where children are placed together” and “percentage of children with identified health needs receiving services to address the need.”
The program is already delivering results. For example, from late 2008 through August of 2009, the State increased family reunifications 34 percent among temporary court wards (TCW). This is a group of children who were identified in a Michigan children’s rights lawsuit as having remained in the system for one year or longer. By combining the “timeliness” and “permanency” measures, the State can identify and work on reuniting children with their families, thereby bringing them to a more permanent living situation faster.
“Michigan has once again shown its national leadership by using advanced technologies to address pressing societal issues – in this case, the protection of children,” said Shelby Solomon, executive vice president, commercial and government health plan solutions at Ingenix. “We are pleased to be part of this breakthrough initiative that facilitates collaboration between two branches of Michigan’s government to conduct the analysis necessary to improve the well-being of these children.”
Michigan began its work with Ingenix in 1994 with the creation of the nation’s first Medicaid data warehouse to monitor claims for quality of care, overpayment and fraud/abuse. Since then, Ingenix and Michigan have worked closely to expand the data warehouse to include information from most of the state’s largest programs, agencies and departments, including SCAO, MDHS, and the State’s Department of Community Health (MDCH).
About Michigan SCAO
The Michigan State Court Administrative Office (SCAO) is the administrative agency of the Michigan Supreme Court, charged with helping the trial courts operate effectively so that they can better serve the public. Among its many responsibilities are: collecting data on courts’ caseloads, including the types of cases each court hears and how long it takes to resolve cases; and overseeing courts’ involvement in various child welfare issues, and offering ways to improve courts’ handling of cases involving children who are or may become court wards.
About Michigan DHS
The Department of Human (DHS) is Michigan's public assistance, child and family welfare agency. DHS directs the operations of child protection, child welfare, public assistance and service programs through a network of over 100 county Department of Human Services offices around the state. Last year, DHS fielded more than 124,000 complaints of child abuse or neglect, and currently serves more than 16,000 children in foster care, residential, or adoptive placement.
About Ingenix
Ingenix, a UnitedHealth Group (NYSE: UNH [FREE Stock Trend Analysis]) company, is a leading provider of health information, technologies and consulting services. Organizations, institutions, businesses and government agencies that comprise the health care system depend on Ingenix solutions and insights to improve their performance. Visit www.ingenix.com for more information.


Michigan State Court Administrative Office (SCAO)
Marcia McBrien, 517-373-0129
Public Information Officer
or
Michigan Department of Human Services (DHS)
Edward Woods III, 517-373-7394
Director of Communications
or
Ingenix
Steve Puleo, 978-294-6418
Corporate Communications