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CMS’s Medicaid Integrity Program is now charging full steam ahead with Medicaid integrity audits, with the agency recently selecting two MIP contractors to conduct audits of Medicaid providers. These audits will review the actions of providers furnishing items or services paid for by Medicaid to determine whether fraud, waste and abuse has occurred, whether the actions of entities resulted in overpayments, and, if so, the magnitude of the overpayments.

Providers that are customarily more focused on Medicare audits are well-advised to shift their attention to Medicaid audits now heading their way. While some of the challenges are the same, Medicaid offers different areas of concern, different risks, and different steps you must take. Most hospital coders haven’t been trained in Medicaid. These providers of services to Medicaid beneficiaries need to take a good, hard look at their billing and coding operations and identify specific risks. Areas such as one-day hospital stays and drugs prone to conversion errors are likely to be the focal points of upcoming audits, and must be incorporated into a provider’s self-auditing procedures. What are the chief Medicaid compliance challenges ahead that may present your greatest risks?

Hear attorneys Judith Waltz and Daniel Reinberg provide strategies for identifying specific Medicaid risks and incorporating these risks into audit procedures. You’ll learn what practical steps you can take to prepare for the inevitable CMS MIP audits ahead and the aggressive Medicaid enforcement that is on the way. Topics to be covered include:

Speakers

Judith A. Waltz is a partner at Foley & Lardner LLP. She is co-chair of the Life Sciences Industry Team, and former vice chair of the Health Care Industry Team. Ms. Waltz regularly advises clients who are the focus of government investigations and other enforcement actions, and has negotiated false claims act settlements with the U.S. Department of Justice as well as corporate integrity agreements (CIAs) with the Office of Inspector General. She then has worked closely with those clients to implement their CIAs, including ongoing advice in connection with IRO audits and reviews. At the state level, she has been involved with various Medi-Cal audits and investigations, including one large matter involving allegations of inflated drug pricing by a major pharmaceutical company.

Daniel S. Reinberg is partner in Foley & Lardner's Chicago office, where he is a member of the White Collar Defense & Corporate Compliance Practice of the litigation department. He represents health care providers in criminal fraud and abuse investigations and civil False Claims Act lawsuits, among other matters. Mr. Reinberg has provided counsel to numerous providers concerning OIG’s Self Disclosure Protocol. Prior to joining the firm, Mr. Reinberg worked as an assistant U.S. attorney in the United States Attorney's Office for the Northern District of Illinois.

Moderator: Barbra Golub, JD, editor of Medicaid Compliance News

Designed Especially For

Compliance officers, legal counsel, business planners, physician leaders, government affairs officers, and contracting officers at:

• Hospitals and health systems
• Medical group practices
• Other physician and provider organizations
• Health plans

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