Integrity program saves Iowa Medicaid $49 million

DES MOINES - An initiative focusing on Medicaid payment accuracy has saved taxpayers an estimated $49 million in fiscal 2014, the Iowa Department of Human Services said this week.

This brings the four-year savings of the program to nearly $129 million - about $30 million above the estimated targets, DHS said.

'This is good news for the Medicaid program as we continue to work to contain costs and improve the delivery of quality care,” DHS Director Charles Palmer said in a release. DHS administers the Medicaid program.

Minnesota-based Optum helps the program cut down on potential fraud or inappropriate claims and payments. The company was awarded a three-year, $14 million contract in fiscal 2011, along with an optional year worth $4 million for fiscal 2014.

DHS said about 40 percent of the savings under the program come from cost avoidance - or money not spent because claims errors or fraudulent activities are caught in advance. The other portion is from recoveries, which refers to funds inappropriately billed to Medicaid that providers must pay back to the program.

Optum said it discovered inappropriate behavior by both providers and beneficiaries.

The majority of the state's Medicaid providers bill appropriately and understand how the program works, Palmer said, but the few who are fraudulent 'have been put on notice that we're using sophisticated techniques to thwart their efforts and ensure accurate payments.”

Optum will continue its program integrity efforts for fiscal 2015 in the second of two performance-based option years under the contract.