HMS, a wholly owned subsidiary of HMS Holdings Corp. (NASDAQ:HMSY), announced today that it has achieved $3.1 million in Medicaid Recovery Audit Contractor (RAC) recoveries through collaboration with New York State’s Office of the Medicaid Inspector General (OMIG) and a corporate provider.
Using a process that compares commercial carrier paid claim data to Medicaid paid claim records, HMS identified a potential systemic coordination of benefits issue with Medicaid billings within one of the provider’s facilities. HMS then worked with the corporate provider to identify the affected claims at all of the provider’s stores. After engaging in a targeted self-review of their secondary and tertiary billings to Medicaid over the prior three years, the provider ultimately identified over 350,000 incorrectly billed prescriptions across the company’s 758 New York facilities.
“This is the largest single finding that HMS and OMIG have identified since HMS was designated as the State’s Recovery Audit Contractor in April 2011. It demonstrates the value and effectiveness of the collaborative approach that HMS takes with our clients and providers,” said Maria Perrin, HMS’s Chief Business Officer.
HMS has performed third party liability and program integrity services on behalf of New York since 2002. During that time, HMS has recovered over $1 billion on behalf of New York Medicaid and has generated billions more in cost avoidance savings.About HMS HMS is the nation's leader in coordination of benefits and program integrity services for healthcare payers. HMS's clients include health and human services programs in more than 40 states; commercial programs, including commercial plans, employers, and over 135 Medicaid managed care plans; the Centers for Medicare and Medicaid Services (CMS); and Veterans Administration facilities. As a result of the company's services, clients recovered over $2.5 billion in 2011, and saved nearly $7 billion through the prevention of erroneous payments.