CGI triage of Pennsylvania Medicaid system saves millions

Audits and other analysis feret out improper payments

CGI will continue to provide Medicaid payments oversight for the Commonwealth of Pennsylvania under a six-year contract renewal worth almost $45 million.

The award from the Pennsylvania Department of Public Welfare calls for CGI to help prevent, detect, deter and correct provider improper payments within its Medicaid Medical Assistance program, according to a May 31 company statement.

Under the contract, CGI will use its proprietary data-mining software, the Customized Audit System, to conduct claims and records reviews, identify over and underpayments for recovery, and provide support for appeals activities, the announcement said.

With enrollment in Pennsylvania’s Medicaid Medical Assistance program providing health care benefits to approximately 2.1 million people, the Public Welfare Department requires constant, careful reviews to ensure that health care dollars are spent to provide quality medical services and not lost to improper payments, the announcement explained.

During the past 20 years CGI’s claims review partnership has helped Pennsylvania recover nearly $69 million in improper payments, Nazzic Turner, CGI senior vice president and general manager of U.S. enterprise markets, said in the announcement.

CGI is a subsidiary of CGI Group Inc., of Montreal, Que., which ranks No. 41 on Washington Technology’s 2011 Top 100 list of the largest federal government contractors.

About the Author

David Hubler is the former print managing editor for GCN and senior editor for Washington Technology. He is freelance writer living in Annandale, Va.

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