Ellen Perlman was a GOVERNING staff writer and technology columnist.
E-mail: mailbox@governing.comTwitter: @governing
Technology
To Catch A Thief: N.Y. Localities' New Route To Rooting Out Medicaid Fraud
New York counties, which finance $7 billion a year in Medicaid services, are tapping a new software to catch providers who lie, cheat and steal public dollars with various frauds.
Designed by IBM for the New York State Association of Counties, the software can comb through and analyze medical claims to look for mathematical anomalies. If it "sees" that, say, nearly 5,000 students were sent into speech therapy in one day without evaluation or that one dentist is billing for 1,000 dental procedures a day, the software will report the unusual activity.
It can review providers and recipients and cross-check names and identities to see if false names are being used. The program also can provide peer analysis. It can look at all the cardiologists and compare doctor "X" against doctor "Y" to see if something unusual is going on.
Counties can choose from 19 review categories, such as hospitals or family practices or dentists.
"The county selects what it wishes to profile, where it might have an instinct that there are problems," says Stephen J. Acquario, executive director of the counties association.
New York counties previously did not have the authority to investigate health care provider activity. They could look only at fraud on the part of Medicaid recipients. Now, the counties are pairing with the state to use this new technology to unearth a wider base of fraud.
It could be a goldmine. The U.S. Government Accountability Office has estimated that fraud makes up 10 percent of national health care spending, and Medicaid spending alone is approaching $45 billion nationwide.
If you enjoyed this post, subscribe for updates.
Twitter: @governing
Latest from Technology
- Tapping into Big Data in Government
- Cheaper storage and more powerful analytic tools are making big data an increasingly viable concept for the public sector.
- States in a Race to Secure Drone Testing
- Groups in 37 states are vying to become one of six federally designated sites for testing the remotely piloted crafts for use in the nation's airspace. They see a chance to generate jobs.
- Job Skills Gap a Growing Concern in Cities
- Cities coming out of the recession are facing new challenges with matching their workforce to available jobs, a problem that could be an early indicator of a growing national problem.
- 1 U.S. City Makes "Most Intelligent" List
- Of the more than 400 cities that competed for the designation, Columbus, Ohio, is the only U.S. city to be named in this year's top seven.
- Sequestration Cuts into Scientific Research
- Federal agencies pour billions each year into university research. With less federal money to spend, some Ph.D. programs are delaying admissions decisions, while others have already cut positions amid the uncertainty.
Events & Webinars
- It’s A Paperless, Paperless World..... Thinking Outside the Box to Gain Efficiencies through Prepaid Cards
- April 23, 2013
- Public sector organizations are under intense scrutiny to operate as efficiently and effectively as possible and with maximum transparency. An important consideration is the way in which payments are made and managed. Prepaid cards can offer flexibility, security and accountability to governments as a method of dispersing benefits, healthcare and social care payments, child benefits and housing benefits to their constituents.
- GOVERNING - Michigan Leadership Forum 2013
- May 1, 2013
Twitter
Facebook
LinkedIn
YouTube
Flickr
RSS
© 2011 e.Republic, Inc. All Rights reserved. |