State Member Ann Kaperak
State Member-
Ann Kaperak replied to the discussion MCO Benchmarks in the forum State Only Forum 3 years ago
Hi Kari! We have one right now and are considering others. Please see the attached. I think it explains it pretty well and we use it on a fiscal year basis (July 1 to June 30). It centers around reporting fraud to our MFCU partners. It is based on 3 factors, recipient enrollment, capitation and provider numbers. On the document, the PNV is…
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Ann Kaperak replied to the discussion MCO Contracts and Program Integrity in the forum State Only Forum 3 years ago
Reply to MCO Contracts and Program Integrity
Florida’s core contract is attached. I bookmarked the Compliance, Fraud/Abuse, Sanctions, and Liquidated Damages sections. Please reach out by email to me if you have any questions. I am happy to answer any of them.
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Ann Kaperak replied to the discussion Preclusion list in the forum State Only Forum 3 years ago
Dawn – this is something a few of our Medicaid health plans do. I cannot speak to this prevention practice as whole though for our state.
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Ann Kaperak replied to the discussion OIG/PI Unit Composition in the forum State Only Forum 3 years ago
Reply to OIG/PI Unit Composition
1. Number of managed
care recipients. – 4,197,317 (as of March ’22)2. Number of
fee-for-service recipients. – 1,109,750 (as of
March ’22)3. Number of MCOs. – 11 Managed Medical
Assistance and LTC/LTSS, 5 of the same 11 also have managed care contracts to provide specialty care related to HIV/Aids, Serious Mental Illness, Child Welfare, etc.… -
Ann Kaperak replied to the discussion OIG/PI Unit Composition in the forum State Only Forum 3 years ago
Reply to OIG/PI Unit Composition
Give me just a few minutes and I will answer for Florida.
