Please note that this article is applicable to
Florida hospice providers only.
In 2003, the Centers for Medicare and Medicaid Services (CMS) initiated a project with the state of
Florida designed to share and analyze both Medicare and Medicaid data to better coordinate benefit integrity efforts between the two programs. Now known as Medi-Medi, claims data from both programs is analyzed together to detect patterns that may not be evident when billings for either program are viewed in isolation. As a result of combining the data, previously undetected patterns can be identified, such as 'time bandits;' that is, providers who bill for a total of more than 24 hours in a day to both programs. This project allows vulnerabilities in both programs to be identified, and where appropriate, actions can be taken to protect the federal share of Medicaid and Medicare dollars.
First piloted in
California in 2001, Medi-Medi is being expanded nationally with the enactment of the Deficit Reduction Act of 2005. In all of the projects, federal and state law enforcement and program integrity partners work together to identify fraudulent behaviors.
Since 2005, the Florida Medi-Medi project has generated 38 investigations with over $57 million in overpayments associated with those investigations. A recent project, which matched hospice claims data between the two programs, uncovered the following activity:
Analysis was conducted on claims for hospice services furnished to dually eligible Medicare and Medicaid recipients. Over $1.8 million was identified in duplicate payments for 262 dually eligible recipients; that is, both Medicare and Medicaid each paid for the same services as a primary payer where Medicare should have been the primary payer. The State overpaid hospice providers who submitted the duplicate claims and is recovering the over $1.8 million in overpayments. Without the data matching, the overpayments would not have been identified nor recovered.
These are the types of patterns that a project like Medi-Medi, which shares and compares billings from both programs, is uniquely designed to discover. All Medi-Medi projects conduct analyses to determine if, and to what extent, vulnerabilities, fraudulent activities, and/or overpayments may exist.
SafeGuard Services LLC is the Zone Program Integrity Contractor (ZPIC) for Florida,
Puerto Rico , and the U.S. Virgin Islands. The ZPIC is responsible for identifying and investigating health care fraud for the Medicare program. Its scope of work also includes the Florida Medi-Medi Data Matching Project in collaboration with the Agency for Health Care Administration’s (AHCA) Office of Inspector General/Medicaid Program Integrity (IOG/MPI) and the Medicaid Fraud Control Unit.