Monday, March 21, 2011

HHS wants to give states fed money for data mining

The Health and Human Services Department has proposed that state Medicaid agencies be able to use federal funds to help pay for uncovering fraud through the screening and analysis of Medicaid claims data.  

While it sounds high tech and cool, I'm not so sure it will work.  The most effective fraud schemes we've uncovered would have never been detected through data mining, at least not with the data mining protocols currently being used (and it's my understanding the ones under development).  That's because the really clever fraudsters know how to game the system over time.  They fly just under the radar.  Almost every health care fraud case I'm aware of has been broken by an insider.

Remember,  our 3rd-party, electronic reimbursement payment system is based upon the honesty of the person submitting a bill.  With a $1 Trillion appropriation, it just takes a few dishonest "providers" to cause serious harm to the fiscal integrity of Medicare and Medicaid. 

Click here for a news story.

Click here for the announcement in the Federal Register.


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