Florida’s Benefit Recovery

Documented Procedures

We found that BR processes and procedures had last been formally documented when the new system was launched 6 years earlier. In response, we worked with staff to develop process maps of the key processes. Working with the staff, we found many instances of delays, handoffs, and errors. We observed that although BR built and installed a new system only 6 years ago, the processes were still mostly manual—that the system was only a place to record things, not a decision support system.

Reviewed the performance and operations of the Private Collection Agency – we reviewed the performance over the past five years. We found many areas for possible improvement. Again, we found that the vendor personnel had made many great ideas for improvement: ideas that had never surfaced to the right level where decisions could be made. We also went back to the contract first penned 6 years ago to discover that the actual operations were no longer in line with the contract. Also, we found many forms of rough handoff, including the finding that the vendor was reentering large amounts of data because the BR system was delivering key data as a PDF report instead of as fielded data that the vendor system could just read.

Assessed systems – We documented the high level architecture, making note of key issues. We found that although BR had recently invested in an electronic archival system, it still lacks document management, workflow and many systems tools needed to support claim investigations.

Assessed operations of the fraud prosecution operation within the Attorney General’s office – unlike some other states, fraud investigation and prosecution is separated from claims investigation. We found that this separation generated rough handoffs and added costs.

Reviewed the Numbers.

Developed and analyzed a database of all the transactions to review activities – we found that BR had only the most basic numbers to track their operations. To get a better view, we extracted all the transactions over the past five years—a database of nearly a million line items. With this we were able to give BR leadership its first glance into the high number of adjustments—60% of all transactions corrected errors or otherwise adjusted claims for reasons that have nothing to do with collecting. We had heard the rumor that there was a large backlog of un-worked claims—we were able to put numbers to the problem, learning that BR had 15 months of referrals that had never been worked.

Reviewed the budget and employment history – BR had an intuition about many aspects of staffing management, but no hard data. We determined historic staff turnover. We also computed for the first time the true impact of telecommuting—which includes 20% of the workforce, but BR had no information on whether it was working out.

Designed a plan to transform Florida’s Benefits Recovery operation

Quick-start to stop the bleeding – Florida will start by investigate backlog. This includes reinvestigating cancelled referrals and re-investigating referrals for companion claims. The total from this one-time effort will be at least $10 to $15 million. In addition, BR faces 20% automatic staffing reduction at year-end, after losing 20% last year. Our quick-start program also identifies a few simple steps that will allow BR to reduce the work required. The crux of these is eliminating non-value added work steps like 100% inspection and unnecessary transfers between regions. This will allow BR to lose27 more people in July—without affecting performance.

Prioritization – BR will start to prioritize referrals (something we helped them copy from Texas). Under this approach, BR will first assess the likely claim size, then work those over $500 first. This will raise the average claim by $700 and increase collections by $10 to $15 million annually.

Improve collection effectiveness – We identified 13 different improvements to collections. This included tools available in other states, such as garnishments and collecting from state employees.Many of these tools are longer-term and require legislative or regulatory approval—but all are “real”. These will add $8 to $10 million to collections annually.

Improve Capture of Claim Opportunities

We found several types of claim opportunities that represent large amounts: post-partum and transitional Medicaid, recover of SSI assets and tapping into lump sum payments. While these are “cost avoidance” and not included in the benefits cases, they will amount to $6 to $10 million annually. In addition, we laid out a plan for using what BR learns as a key input into eligibility management “upstream”. This could amount to many tens of millions annually.