Florida PSC Tasks Awarded

Project Background

On January 25, 2005, the Centers for Medicare & Medicaid Services (CMS) awarded a new contract to EDS (Electronic Data Systems) and its subcontractor, IntegriGuard, LLC, to establish the Florida Benefit Integrity Support Center (FLA-BISC). This project is part of the CMS Medicare Integrity Program (MIP) to engage Program Safeguard Contractors (PSC) in pursuit of Medicare fraud, waste, and abuse in the State of Florida.

As the prime contractor, EDS replaces TriCenturion, effective March 1, 2005, as the PSC responsible for combating and preventing Medicare fraud and abuse in Florida. In this capacity, EDS is generally responsible for data-analysis, investigation, and case development for the FLA-BISC. IntegriGuard, acting as a subcontractor, performs medical and financial reviews as well as education services for the FLA-BISC. In addition, EDS has been engaged to replace TriCenturion in its work performing data analysis and investigative work as part of the Florida Medicare / Medicaid Data Analysis Center (FMMDAC). This project is being closely coordinated with the Florida Agency on Health Care Administration (AHCA).

The FLA-BISC does not replace the Medicare program administration work performed by First Coast Service Options (FCSO), the current Florida Fiscal Intermediary (Part A) and Carrier (Part B). FCSO, the Affiliated Contractor (AC), will continue its current responsibilities including processing and paying claims, performing customer service, reviewing the medical necessity of claims unrelated to suspected fraud and abuse, and auditing facilities for Medicare expenses and reimbursement.

Project Purpose

The FLA-BISC will create a focused resource to detect and deter fraud in the Medicare Part A and Part B programs. In this capacity, it will develop administrative solutions, investigations, and cases for referral to law enforcement, as well as provide ongoing support for those cases as needed. Additional responsibilities include coordination of BI activities in the region, and dissemination of relevant BI information to the related AC, providers, and beneficiaries.

Expected Outcomes

• Identification of situations of potential fraud, waste, and abuse in the Medicare program for case development and referral to law enforcement
• Timely and accurate resolution of complaints alleging fraud
• Identify Medicare program weaknesses, vulnerabilities, and make recommendations for corrective actions, including prepayment reviews, overpayment recovery, and provider education
• For FMMDAC, identify questionable behavior that crosses both health care programs and make recommendations and referrals for education, policy revision, overpayment recovery, and referral to law enforcement

FLA-BISC and FMMDAC Locations

EDS / IntegriGuard
Medicare PSC Team

3450 Lakeside Drive
Suite 201
Miramar, FL 33027

EDS / IntegriGuard
Medicare PSC Team

Baypine Road
Jacksonville, FL 32256

Questions regarding the FLA - BISC may be directed to:

Paul Duplinsky
Acting Benefit Integrity Manager
EDS/IntegriGuard PSC Team
3450 Lakeside Drive, Suite 201
Miramar, FL 33027
954.433.6423 (phone)
paul.duplinsky@eds.com

Patty Aguilera
Acting Education/Outreach Coordinator
IntegriGuard FLA-BISC
2121 North 117 Avenue, Suite 200
Omaha, NE 68164
402.498.2532 (phone)
402.955.0783 (facsimile)
p.aguilera@integriguard.org

Cathy Failor
Program Manager
EDS FMMDAC
225 Grandview Avenue
Camp Hill, PA 17011
717.975.4438 (phone)
717.975.4244 (facsimile)
cathy.failor@eds.com