NYS DOH Medicaid Data Warehouse & Analytics - CMA Consulting Services

NYS DOH Medicaid Data Warehouse & Analytics Learn how CMA is helping NYS achieve its #1 ranking in fraud detection and recovery.

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New York State needed a partner to help create a comprehensive and secure health care information system environment. This environment had to position NYS to meet the emerging needs of the next decade. They needed to better manage their annual $50 Billion Medicaid Program to improve fiscal oversight, program integrity and control fraud and waste through improved big data management and enhanced analytics.

CMA’s Solutions

CMA was selected to develop and implement a replacement Medicaid Data Warehouse (MDW) solution and assume responsibility for the operational support of the current Office of Health Insurance Programs (OHIP) Data Mart.

The MDW plays a central role in New York State’s Medicaid program. NYSDOH views the MDW as a resource serving State and local government, as well as Federal government, with plans for future expansion to use by non-government healthcare professionals.

In 2012, CMA implemented an enterprise solution (The NYS Clinical Research Database) to provide fast and flexible access over 25 years of claims data and provide actionable information to achieve significant program improvements and cost savings.

The MDW helps offer better management and manipulation of health care claims information while meeting all Health Insurance Portability and Accountability (HIPAA), including 5010, and Health Information Technology for Economic and Clinical Health Act (HITECH) requirements.

The Results

NY OMIG Recovers millionsAccording to the Office of Medicaid Inspector General (OMIG), NYS recovered $879 million in 2013. These represent record breaking figures. OMIG now has recovered more than $1.73 billion in improperly expended Medicaid funds over the past three years.

These savings have gone a long way in filling New York State budget gaps and supporting future efforts of the program through the reinvestment of these savings.

NYS currently ranks #1 in the nation for fraud detection and recovery at a little over 1% of total. Additionally, over the last five years, New York State alone accounted for more than 54 percent of the national total of fraud, waste, and abuse recoveries.