Project Summary 

• Provide independent evaluation and Independent Verification and Validation services on novel Medicaid Access Card program with over 200,000 enrollees and 2000 locations

IBG Responsibilities  

• Develop fraud detection and deterrence methodologies
• Evaluate and verify effectiveness and compliance of vendor operations and technical solutions
• Test and analyze vendor systems for accuracy, usability, stability
• Provide a systems compatibility review of the Pilot solutions with the Lone Star Imaging System (LSIS) and Women, Infants and Children (WIC) biometric identification systems.
• Conduct data privacy analysis, security analysis, and HIPAA / HL7 compliance analysis
• Provide a cost-benefit analysis to determine projected savings due to fraud reduction
• Support HHSC in legislative presentations and committee discussions on program implementation roadmap

In 2003, the Texas Health and Human Services Commission (HHSC) engaged IBG to provide independent evaluation and IV&V services on its Front End Authentication and Fraud Prevention System Pilot Program, also known as the Medicaid Integrity Pilot (MIP). This groundbreaking program - one of the first public sector programs in the U.S. to utilize smart card and fingerprint technology for client authentication - required the services of an independent firm with expertise in biometrics, smart card technology, user perceptions, and privacy assessment.

The MIP pilot was initiated through State House Bill 2292 to address the alarming increase in phantom services and upcoding on the part of Medicaid providers. Four separate systems integrators' solutions were deployed in the first MIP phase, each with a different biometric, smart card, and application architecture. Fingerprint and smart card systems were deployed to nearly 1000 medical providers, and cards were issued to over 150,000 Medicaid recipients. Pilot participants enrolled fingerprint data onto their smart card at the provider's office. On return visits, participants verified their identity by matching their fingerprint against the previously-enrolled data. Pilot data was used to analyze patterns of client and provider fraud.

IBG continued with HHSC as the MIP pilot became the Medicaid Access Card (MAC) program. The MAC program substantially expanded pilot scope to thousands of providers and hundreds of thousands of card recipients. The MAC program was the last stage before statewide deployment of fingerprint and smart card technology.

Through both the MAC and MIP programs, IBG evaluated and reported on all aspects of pilot and program performance, from system accuracy and usability to client and provider acceptance. IBG and its subcontractors conducted hundreds of site visits across the state. IBG also evaluated solutions' HIPAA and HL7 compliance. IBG also conducted outreach to clients advocates and stakeholders to facilitate decisions on statewide deployment. IBG evaluated systems' fraud detection and deterrence capabilities and reported on the likelihood of cost avoidance. IBG's work over a three-year period was central to program planning and execution.