Baize will speak about new federal payment integrity efforts that affect Medicare and Medicaid. These efforts will focus on fee-for-service payments, Medicare Advantage, and Medicaid managed care. As the line between public payers and private payers continues to be blurred, the policies and rules coming out of the federal Centers for Medicare and Medicaid Services (CMS) will affect nearly every payer and plan.
CMS continues to place much of its focus on healthcare supplies and services that are fulfilled outside institutional settings. Home-based care, durable medical equipment and disposable medical supplies remain under increased scrutiny as areas that CMS has deemed at high risk for fraud. Laboratories and specialty pharmacies are also being more closely monitored.
Additionally, as required by the 21st CURES Act, electronic visit verification (EVV) of home-based services is now implemented throughout the U.S. Payers should see a reduction in claims for those services, but that depends on whether states implemented EVV consistently, and whether providers willing to commit fraud have already found ways around the technology.
Finally, Baize will provide recent examples of successful healthcare fraud prosecutions from around the U.S.
Anthony Baize
Anthony J. Baize is the Inspector General for the Wisconsin Department of Health Services. Baize took the position in early 2016 after eight years with Kentucky state government in the Kentucky Cabinet for Health and Family Services, serving as the Deputy Director of Audits and Investigations for the Office of Inspector General and the Director of Business Informatics with the Department of Behavioral Health, Developmental and Intellectual Disabilities.
Baize has served as the Region V representative for the National Association of Medicaid Program Integrity Directors and on the Advisory Board for the Centers for Medicare and Medicaid Services’ Medicaid Integrity Institute. He regularly speaks at national conferences on topics related to Medicaid Program Integrity.
Baize became a certified inspector general in 2022 after completing the Association of Inspectors General Institute. He is also a member of the Internation Association of Financial Crimes Investigators.
Baize was a civil rights consultant for nearly 20 years, serving on the Board of Directors for the National Fair Housing Alliance and the Lexington (KY) Fair Housing Council. Baize has given presentations on fair housing requirements across the United States, but especially in Kentucky, Indiana, Ohio and Tennessee. He has a master’s degree in public administration from Indiana State University, has been married for 29 years and has two daughters.