Traditional methods of trying to nab healthcare fraud are like "fishing with a cane pole," North Carolina Health and Human Services Secretary Lanier Cansler told Businessweek. But a new software program that crunches raw Medicaid claims data will give the state powerful depth finders to recover tens of millions of inappropriately paid dollars.
With budgets tighter than ever, more organizations are looking to recoup funds that are rightfully theirs, with several pilot programs throughout the country using technology to catch fraud and costly administrative mistakes. Such programs also play a key role in President Obama's plans to crack down on healthcare fraud.
In North Carolina, the software will work by electronically scanning Medicaid data to identify suspicious trends among the nearly 2 million Medicaid patients and 60,000 Medicaid providers in the state. Instead of buying the technology outright, the state will pay manufacturer IBM an amount equal to 10 percent of the money it determines should be recouped because services were fraudulent or unnecessary, with the company's total capped at $5.4 million annually.
Though the anti-fraud system won't be fully implemented until this summer, it has already detected some unusual activity warranting further investigation, according to Businessweek.
For more information:
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