HomeMy WebLinkAbout(0069) M&C 22-0213City of Fort Worth, Texas
Mayor and Council Communication
DATE: 03/29/22 M&C FILE NUMBER: M&C 22-0213
LOG NAME: 14SMARTLIGHTAMENDMENT
SUBJECT
(ALL) Authorize an Amendment to a Professional Services Agreement with SmartLight Analytics to Adjust the Compensation and Term for an
Amount Up To $600,000 Per Year for Five (5) Years.
RECOMMENDATION:
It is recommended that the City Council authorize an amendment to a Professional Services Agreement with SmartLight Analytics to adjust the
compensation and term for an amount up to $600,000 per year for a period of five (5) years.
DISCUSSION:
The purpose of this Mayor and Council Communication (M&C) is to seek authorization from the City Council to amend a Professional Services
Agreement (City Secretary Contract No. 52069) with SmartLight Analytics, LLC to adjust the compensation and term of the contract for an amount
up to $600,000.00 per year for a period of five (5) years.
In 2019, the City of Fort Worth (City) contracted with SmartLight Analytics to provide claim review for the City's Medical and Pharmacy plans. In
2021, SmartLight Analytics saved the City $2.6 million in fraud, waste and abuse claims and identified 17 pharmacies engaged in fradulent
practices which had the potential to cost the City $800,000.00.
Through their data analytics and clinical expertise, SmartLight is be able to identify fraudulent billing such as:
■ pass -through billing schemes where unscrupulous physicians route billing to out -of -network labs who in turn send the claims to in -network
rural hospitals for claims submission in order to receive reimbursement at 20-30X average payments or;
■ medically unnecessary abusive urine drug screening and genetic testing claims; and/or
■ identifying claims submitted that violate the anti -kickback laws.
SmartLight's monitoring of wasteful claims also includes, monthly interventions to reduce:
■ overuse of emergency rooms services;
■ billing of medically unnecessary services such as long-term, high frequency testosterone replacement therapy; and/or
■ payments for misrepresented services (such as investigational treatment of sublingual hormone drops billed as allergy treatment);
■ payments for non -rendered services (based on patterns that are medically unlikely), coding errors, or duplicate payments that bypass the
plan administrator's adjudication process.
Once a wasteful claim is identified, SmartLight passes that information on to our current medical and prescription providers and works within the
administrator's existing processes to deny and/or credit payments back to the City. Additionally, our medical or prescription providers may report
these findings to authorities to help curb the abuse throughout the healthcare system. SmartLight provides a quarterly report on progress of
refunded payments to the City.
SmartLight Analytics is a WBE Certified Business.
Funding is budgeted in the Consultant & Other Professional Service account of the Human Resource Health Benefits Admin Department's Group
Health Insurance Fund
FISCAL INFORMATION / CERTIFICATION:
The Director of Finance certifies that upon approval of the recommendation, funds are available in the current operating budget, as previously
appropriated, in the Group Health Insurance Fund. Prior to an expenditure being made, the Human Resources Department has the responsibility
to validate the availability of funds.
Submitted for City Manager's Office by. Reginald Zeno 8517
Originating Business Unit Head: Dianna Giordanno 7783
Additional Information Contact: