State Member Rebecca Hebert
State Member-
Rebecca Hebert replied to the discussion Question about MCO Contract Approval Issues Due to Finders' Keepers Language in the forum State Only Forum a year ago
Reply to Question about MCO Contract Approval Issues Due to Finders' Keepers Language
Hello, it’s a valid question. We (Louisiana) have asked questions like this to our actuaries before, and generally the actuaries tend not to be concerned about SIU or Program Integrity recoveries, because the service dates tend to be old enough that they do not affect future rates. Our MCOs report financials quarterly, including income…
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Rebecca Hebert replied to the discussion UPIC Session at NAMPI Annual Conference in the forum State Only Forum 2 years ago
Reply to UPIC Session at NAMPI Annual Conference
The UPIC makes referrals to CMS and OIG (Federal law enforcement) via the MCC process. The State and MFCU attend the MCC call. The State does not see the referral for up to 7 days after the MCC meeting. The State has no communication with OIG (Federal), only MFCU (state) and UPIC (Federal). For the UPIC, once the referral is submitted to…
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Rebecca Hebert replied to the discussion Prepayment Review in the forum State Only Forum 2 years ago
In Louisiana, we can do prepay for FFS, but it’s not broadly used and there are no specific parameters mentioned in the Louisiana Administrative Code about scenarios when we would pend claims. Our MCOs use it, though, and most of them only put a provider on prepay if an audit showed possible fraud or abuse. Prepay for those MCOs tends to…
