Customer Story: Medicaid Program Integrity
The Office of Medicaid Program Integrity (MPI) serves as the primary office within AHCA to fulfill the federal law requirements to operate a fraud, abuse, and waste prevention and detection program within the single state agency responsible for the administration of the Medicaid program.
State law requires the Agency to operate a program to oversee Medicaid provider activities to ensure that fraudulent and abusive behavior occurs to the minimum extent possible in the Medicaid program, and to recover Medicaid overpayments, and impose sanctions for violations against the Medicaid program. MPI also identifies and refers to the appropriate investigatory or regulatory agency, those activities of recipients engaged in potentially fraudulent or abusive behavior, as well as instances of potential neglect of Medicaid recipients.
The MPI unit was operating a decade-old legacy web application (FACTS) to track and manage investigative cases. This application was utilizing outdated technology and was not meeting their current needs. Leadership at MPI desired a system that was more flexible, cloud-hosted, and allowed investigators more options when managing cases.
Cloud Navigator, in conjunction with Column Technologies, proposed a cloud-based case management tool based on the BMC Remedy platform. This solution is hosted in Microsoft Azure’s Government Cloud. The benefits of using the Government Cloud are numerous and include:
- Strict validation program to determine eligibility before organizations can move their workloads
- Complete data, applications, and hardware residency in the continental United States
- Geo-replication between datacenters 500 miles apart supporting business continuity
- Specially constructed datacenters with 24×7 monitoring
- Physical separation within the continental US, operated by screened US citizens
The new cloud-hosted FACTS system is an n-tiered platform with Development, Testing, and Production environments. All servers are joined to the AHCA network via a site-to-site VPN. ISC manages and maintains all cloud resources, while still allowing access by AHCA IT administrators.
The solution implemented by ISC is both flexible and scalable. In the event that more computing power is needed, any of the Virtual Machines (VM) that host the FACTS system can be upgraded immediately. If a VM is no longer needed, it can be deallocated to save resources. Geo-redundant storage (GRS) replicates MPI’s data to a secondary region that is hundreds of miles away from the primary region. This makes their data durable even in the case of a complete regional outage or a disaster in which the primary region is not recoverable. Additionally, SQL Server Managed Backup to Microsoft Azure allow for recovery from any database failure.