NAMPI 2022 Recap
Integrity Advantage had a fabulous time hosting our first booth at the National Association of Medicaid Program Integrity, or NAMPI, conference. One of our Rockstars shares her impressions as a first-time attendee of this conference. Download the PDF for highlights and hot topics from this year's event.
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The National Association of Medicaid Program Integrity, or NAMPI, recently held its annual 2022 conference in Baltimore, Maryland. Coming off of the pandemic, this year's event offered both virtual and face- to-face options for attendees to join sessions and participate in four days of sessions, presentations, discussions, and networking opportunities. The NAMPI executive board really pulled out all the stops to make this event one worth attending!
As a first-time attendee, I am pleased to share some of the highlights and hot topics from this year's event, for those who may be newer to this industry, event or were just unable to attend the conference.
HOT TOPICS IN MEDICAID PROGRAM INTEGRITY
Covid Schemes
As one can imagine, the pandemic resulted in a wide array of opportunities for fraud, waste and abuse. Covid schemes are one of the hot topics being investigated by the Office of the Inspector General (OIG). Particular focus centers on fake vaccination cards, fake testing centers, fake contact tracing calls and phony advertising related to 'free' testing that then asks patients to divulge personal health information.
Genetic Testing
According to the OIG, genetic testing schemes are popping up given the vast array of different types of tests available.
In a session presented by Shift and Integrity Advantage, genetic testing schemes are preying on vulnerabilities related to familial health concerns. There is emerging risk and plenty of opportunity for fraudsters to take advantage of people, and in many cases, those taking these tests do not receive any results. Some testing is also lumped into other tests, such as Covid tests, which
essentially are unrelated and medically unnecessary .
Behavioral Health
Most notably, one of the hottest topics of this year's conference centered around behavioral health. Behavioral health covers a wide variety of services, including mental health support as well as therapies related to autism and behavior intervention. Presenters from across the country shared insights about fraud schemes. In Louisiana, an investigation discovered a company mass producing falsified documents. In Arizona, investigators were able to work with law enforcement to identify fraudulent billing based on multiple facilities billing for the same patient on the same day. In Florida, investigators found services did not align with the patient's diagnosis, and were not being rendered by credentialled staff. In a session about Applied Behavior Analysis (ABA), focus on overlapping treatments and excessive billing raised red flags about services being rendered.
LAYERS OF PROGRAM INTEGRITY
NAMPI provided state and federal Medicaid program integrity experts and fraud investigators the ability to intermingle, share insights about hot topics in their state, discuss trends and issues and learn from one another. A variety of vendors that work in the fraud, waste and abuse arena were on-site promoting support mechanisms and technological advancements to assist these state and federal agencies in identifying risk and schemes. Some of the focus of the conference revolved around the layers and players in program integrity. For those that may not be familiar with these acronyms, here are a few:
UPIC: Unified Program Integrity Contractor is an entity contracted by Center for Medicare & Medicaid Services (CMS) under the Social Security Act 1936 to provide audit and investigative assistance to a geographical location related to Medicare and Medicaid program integrity. There are five UPIC entities and three contractors. UPIC works with state partners on investigations and improvements based on CMS reporting.
MFCU: Medicaid Fraud Control Unit focuses on investigations related to quality of patient care in certain residential settings, non institutional settings, and Medicaid fraud concerns. MFCUs operate separately from the state Medicaid office and report data and information to the Office of the Inspector General.
OIG: Office of the Inspector General is the overarching entity that oversees program integrity for the Department of Health and Human Services programs, including investigations related to fraud, waste and abuse and program integrity.
Each entity plays an important role in pursuing fraud, waste and abuse.
Speaking of Integrity
Integrity Advantage is a small, woman-owned business with decades of experience navigating the world of fraud, waste, and abuse. Our team has successfully partnered with health care payers to identify and mitigate risks, complete investigations, delve into data analysis and complete medical records reviews. Our team of subject matter experts are laser focused on identifying new and trending schemes, data mining for potential outliers, and researching the latest topics to maximize your return on investment. Whether you are looking for training and education, enhancing your AI solutions based on current and evolving fraud schemes, or fully outsourcing your SIU, Integrity Advantage has experience you need to get the job done.
Let's connect today to discuss how partnering with Integrity Advantage can benefit your company!
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