# Presentation: 381945

## INTRODUCTIONKimberly R. Pugh, R.N., M.S.EdCenters for Medicare & MedicaidServices (CMS) Baltimore, Maryland

## OBJECTIVES1. Provide an overview of the Harkin    Grantee Project and Complaint    Tracking System.2.  Discuss the Aggregate Reports.

## OBJECTIVES3.  Discuss the Program     Memorandums and Manual.4.  Discuss the current results of the     tracking system.

## PROJECT GOALSThe HGTS is a tool designed by theCMS staff to support our partnershipwith the Administration on Aging(AOA), Department of Health &Human Services (DHHS), and theOffice of Inspector General (OIG).

## PROJECT GOALSThe HGTS is designed to helpmonitor and report Harkin Granteegenerated complaints.

## Program MemorandumsCR 1715 Harkin Grantees: Complaint Tracking SystemCR 1983 Harkin Grantees:Aggregate Report Dates

## PROGRAM INTEGRITY MANUAL (PIM)Program Memorandum CR 1715will be noted in the PIM this monthin Chapter 2 sections 7.0 – 7.4

## SYSTEM DESCRIPTIONThe HGTS is housed on a CMS server and is protected by an authorized user logon.CMS intermediary and carrier staffare responsible for entering andupdating data information related to Harkin generated complaints.

## SYSTEM DESCRIPTIONOnly CMS staff and the contractorshave access to the tracking system.No beneficiary information is on thesystem in order to protect privacy.

## HARKIN GRANTEE ROLEThe Harkin Grantees are responsiblefor sending the contractors all necessary information pertaining tothe complaints (See model complaintform).

## HARKIN GRANTEE ROLEOverall the reporting is being donewell; however, the information needsto be provided in a complete manner(Refer to model complaint form).Keep hard copies of all complaints.

## HGTS DATABased upon the information from thecomplaint referral, the contractor inputs the following data into theHGTS and generates an aggregatereport.

## HGTS DATA INPUTDate of initial entry, provider number, provider address, city, stateand telephone number, project number, Medicare contractor number, overpayment identified,overpayment recovered, Fraud investigation database number(FID #),  administrative action taken and explanation of action. 

## AGGREGATE REPORTSAfter the contractor compiles the database information into an aggregate report, then this report isdistributed to the Harkin GranteeState Project Coordinators everysix months.

## REPORT DATESAggregate Reports are submitted within the second week of July (covering data between January – June).Submitted the second week of January (covering data between July – December).

## CURRENT DATAJanuary 2001 – August 2002Total Complaints =  406Total Resolved Complaints = 226

## FINANCIAL PERSPECTIVETotal amount disputed  $435,092Total amount recovered   $97,007Outstanding balance      $338,085

## CMS CONTACTSKimberly R. Pugh, R.N.Health Insurance SpecialistKpugh@cms.hhs.gov(410) 786-9212

## CMS CONTACTSScott WakefieldHealth Insurance SpecialistSwakefield@cms.hhs.gov(410) 786-4301Binh NguygenSystems SpecialistBnguyen@cms.hhs.gov(410) 786-3682