MicroPact Blog

Helping Medicaid Fraud Control Units Turn the Tide

Leveraging Dynamic Case Management to Ensure Program Integrity

Dion Trahan's avatar

By: Dion Trahan

February 4, 2014 | Case Management/BPM

State Medicaid Fraud Control Units (MFCUs) are underfunded and overburdened, even though they have the Herculean responsibility of rooting out fraud, waste and abuse in their respective Medicaid programs.

I’ve talked to a lot of professionals who have dedicated their careers to maintaining program integrity by fighting fraud, waste and abuse. While their dedication is unmatched, the lack of resources continues to burden them and often prevents them from accomplishing their mission. I believe one way to assist these units in their pursuit of wiping our fraud, waste and abuse can be found in dynamic case management.

MicroPact's entellitrak is a Unified BPM platform that takes a Data-First™ approach to Dynamic Case Management and Business Process Management and is available with fully integrated Document Management, Natural Language Analytics, and Mobile Modules. This Data-First approach puts the power squarely in the hands of the knowledge workers and provides organizations such as Medicaid Fraud Control Units a powerful tool to improve operations and outcomes.

Validation for this line of thinking came to me last year when I was at the National Association of Medicaid Program Integrity annual conference in Baltimore. I met with several professionals who insisted that a dynamic case management system would allow them to do more and better work.

The major business processes for MFCUs can be found in three specific operations:

  1. Intake Validation
  2. Triage Management
  3. Actionable Case Management

Intake Validation is the process of a complaint coming in – generally via a telephone hotline or website. An office needs to know the origin of the complaint and quickly figure out how to categorize it and get to work on validating and investigating the complaint.

Triage Management entails separating the validated complaints from the ones that an office cannot take action on. (These lack evidence, credibility or deal with an issue that isn’t under an MFCU’s jurisdiction.) Too often, deputy directors and investigators, instead of focusing on their primary mission of investigating possible fraud, are shackled to their desks going through emails and fielding phone calls only to find out that the complaint doesn’t belong in their office.

Actionable Case Management is the primary function of a MFCU. Once a case starts, the case workers rely on a case management system to help them collect, store and manage all the data and documents related to the specific investigation.

For the last 16 years, MicroPact has established a reputation of providing federal, state and local agencies with enterprise case management solutions that deliver operational efficiencies along with optimal outcomes. Currently, 97% of all federal agencies with 500 or more employees, use a MicroPact software product. And these customers are loyal as evidenced with MicroPact’s 96 percent renewal rate for products and services last year.

The entellitrak platform provides a solid case management foundation for MFCUs to implement a solution that handles operations from intake to resolution, and allows for a host of other benefits on top of improved operations.

By empowering MFCU’s with powerful dynamic case management solutions, states won’t have to ask these units to “do more with less.” Instead, the government will be empowering them to focus on their core mission -- leaving the time-consuming and administrative burdens to the software.

I’ll be happy to explain the other benefits and features the entellitrak platform brings to MFCUs at the 2014 Annual HIMSS Conference & Exhibition, which will take place Feb. 23-27, 2014, at the Orange County Convention Center in Orlando.

Visit me and the team at booth No. 687 during HIMSS14; click here to schedule an on-site briefing or demo.

About the Author

Dion Santana Trahan was Director, Healthcare & Benefits Solutions Strategist with MicroPact from 2012 - 2016.