Baize will speak about new federal payment integrity efforts that affect Medicare and Medicaid. These efforts will focus on fee-for-service payments, Medicare Advantage, and Medicaid managed care. As the line between public payers and private payers continues to be blurred, the policies and rules coming out of the federal Centers for Medicare and Medicaid Services (CMS) will affect nearly every payer and plan.
CMS continues to place much of its focus on healthcare supplies and services that are fulfilled outside institutional settings. Home-based care, durable medical equipment and disposable medical supplies remain under increased scrutiny as areas that CMS has deemed at high risk for fraud. Laboratories and specialty pharmacies are also being more closely monitored.
Additionally, as required by the 21st CURES Act, electronic visit verification (EVV) of home-based services is now implemented throughout the U.S. Payers should see a reduction in claims for those services, but that depends on whether states implemented EVV consistently, and whether providers willing to commit fraud have already found ways around the technology.
Finally, Baize will provide recent examples of successful healthcare fraud prosecutions from around the U.S.
