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Response to RFP No. MED13002 State of West Virginia ... - DHHR

Response to RFP No. MED13002 State of West Virginia ... - DHHR

Request For Proposal #

Request For Proposal # MED13002 Recovery Audit Contract – Pharmacy West Virginia Health and Human Services Sagebrush Solutions: Overpayment Identification and Recovery Services for Managed Medicaid Name of customer and agency: Molina Contract: N/A (Letter contract) Performance period: January 1, 2005 – July 2010 Technical representative: N/A Contract value: $2+ million Contract type: Contingent Fee POC: John Molina, CFO Address: One Golden Shore Long Beach, CA 90802 Phone number: (562) 435‐3666 x1128 Sagebrush Program Manager: Faith Glover Key Project Staff: Bill Grass, Nora Blay, Eva Stogsdill Project Description/Relevance to the Sources Sought Criteria: Sagebrush was responsible for identifying abuse and recovering Medicaid overpayments in five states. Sagebrush used its SageSuite® data analysis tool that it developed specifically for use in identifying, investigating, and recovering payments. This tool enables Sagebrush to select candidate cases and track the investigation. Payment recovery is accomplished through check requests and automated deductions to future provider payments on the Molina claims payment system. All instances of potential fraud revealed by Sagebrush’s investigations are reported to Molina for action. Sagebrush warehoused and analyzed approximately three years of detailed claims and provider data for approximately 1 million members for this client. Sagebrush also provides written reports and supporting documentation on the weaknesses in the claim processing system, provider contracts, or benefits that could result in waste, abuse, or fraud. 25

Request For Proposal # MED13002 Recovery Audit Contract – Pharmacy West Virginia Health and Human Services Sagebrush Solutions: Audits of Medicare Advantage and Part D Drug Plans Name of customer and agency: Centers for Medicare and Medicaid Services Contract: HHSM‐500‐2010, etc. Performance period: 9/28/2007 ‐ present Technical representative: Julia Gorner Address: 7500 Security Blvd. Baltimore, MD 21244 Phone number: (410) 786‐4555 E‐mail:julia.gorner@cms.hhs.gov Sagebrush Program Manager: Sally Reaves Contract value: $2+ million Contract type: Fixed Fee Key Project Staff: Andrew Perry, Tariq Shaikh, Sally Reaves, Eva Stogsdill, Kent Dennis, Susan Reaves, Darlene Wojnarowski Project Description/Relevance to the Sources Sought Criteria: Sagebrush (directly and through subcontracts with Bland Associates & David‐James) performed/is performing approximately reviews of Medicare Advantage and Part D plans for plans years 2006 through 2011. Initially, work was awarded through a one‐year fee‐fee contract to Sagebrush. In subsequent years, work was awarded through multiyear umbrella contracts perform examinations of a number of Medicare Advantage (MA) organizations and Prescription Drug (PD) plans, as well as Agreed‐Upon Procedures engagements for Medicare Managed Care Organizations (MCOs). Under these contracts, Sagebrush performed audits of more than 100 Part D Prescription Drug Plans. Audits determined the accuracy of reported to CMS Prescription Drug Event (PDE) data, sufficiency and adequacy of internal controls over medical and drug claims payments, and finally accuracy of base period data reported on the MA and PD plan bids. 26

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