The State of Texas Health and Human Services Commission (HHSC) has oversight for the Texas Medicaid Program, which has more than two million Medicaid Recipients and over 100,000 providers. HHSC wants to reduce fraud, abuse and waste within that program.

The Challenge

The State of Texas Health and Human Services Commission (HHSC) has oversight for the Texas Medicaid Program, which has more than two million Medicaid Recipients and over 100,000 providers. HHSC wants to reduce fraud, abuse and waste within that program. Although fraud may occur in many forms, certain fraudulent activities can be reduced by using smart card and biometric technologies that identify the provider and recipient at the time services are delivered.

These technologies deter the sharing of a Medicaid Identification Card and help prevent providers from billing for services that are not actually performed.

In addition to preventing fraud, HHSC has a vision that drastically streamlines the Medicaid eligibility systems. Atos Origin was selected by HHSC to participate in a pilot that deployed an ID card and demonstrate the viability of consolidating other programs onto one card.

Our Solution

Atos Origin deployed its biometric solution to Medicaid Recipients and providers in Tarrant County. The pilot project began in January 2004 and ended in March 2005 and was conducted in the following major phases:

• Three-month implementation phase
• Nine-month operational phase
• Three-month analytical and reporting phase

The business solutions we implemented as part of the pilot went beyond technology to include the following:

Conducted Health Insurance Portability and Accountability Act (HIPAA) Awareness and Training – HIPAA governs the policies and procedures that surround the handling of protected health information. All project team members (including subcontractors and call center personnel) were trained on the policies and procedures in handling information for this population.

Conducted Medicaid Application Integrity Pilot – The purpose of this pilot was to evaluate the technology. We loaded an application that recognizes the ID card and performs certain transactions for assisting with evaluation. The biometric card used during the pilot allowed Medicaid Recipients to be enrolled during the first visit at the provider’s office (the biometric finger template was put on the card, and only the card). During the pilot, service is not denied and assurances were made so that neither the provider nor the recipient were aware of the results of the biometric match. Multiple transaction types were captured and sent to a transactional database that allowed the technology to be further evaluated.

Issued 30,000 Biometric Cards to Medicaid Recipients – Atos Origin sent a letter (in English and Spanish) to 30,000 Medicaid Recipients that introduced the program and welcomed them to the pilot. Then we sent a subsequent letter with the card attached and an overview of “What to Expect at your Doctor’s Office,” which provided a walk-through of check-in and check-out procedures during the pilot.

Set Up 150 Provider Sites with Biometric Technology – We deployed the technology at 150 provider sites, including hospitals, doctor and dental offices and training the staff at each site. Prior to installing the software, we conducted surveys to assess the various technical environments in which the software would be deployed.

Supplied Analytical Reporting Models and Interfaces to HHSC Systems – Atos Origin provided HHSC with a set of standard reports, a reporting tool that facilitates ad hoc reporting and interfaces to transactional data to assist with analyzing the pilot.

Provided Support Center and Call Center for Recipients and Providers – We set up a multi-language call-center that responded to questions from recipients and providers. We also set up regional depot service centers to supply “break-fix” components and respond to other technology-related provider needs.

“One Card/ Multiple Program” Card – We went beyond the pilot requirements to demonstrate our capabilities to integrate multiple functionalities such as eligibility confirmation, information about dependents and management of other State programs such as WIC (Women, Infants and Children), and TANF (Temporary Assistance for Needy Families).

The Benefits

Through the successful pilot, The State of Texas Health and Human Services Commission determined that the smart card bimetric and technology is an effective solution and plans to move forward with full deployment. The dollars saved during the pilot by preventing abuse of the benefits and eliminating waste well exceeded the cost of the project. The smart card has proven to be a deterrent to fraud and has been widely accepted by the Medicaid recipients and medical providers.