SIUs should cast skeptical eye on some health data

Data aren't always accurate, complete or reliable, so fraud fighters should view them with awareness that "the quality of the information upon which the government relies has often been in doubt," according to Forbes.

Case in point: The Medicaid Interstate Match Program has incomplete data because state participation in the program has been low, as FierceHealthPayer: Anti-Fraud reported. The program aims to flag beneficiaries enrolled in Medicaid in more than one state and decrease overpayments due to double or triple dipping.

But an Office of Inspector General audit found that in three-months, 14 states didn't submit data into the program for all their Medicaid recipients, the article noted. And states failed to verify nearly 70 percent of potential matches identified to confirm they weren't false positives. As a result of these and other problems, the Match Program recaptured zero overpayments in the audit period, Forbes reported.

Moreover, the OIG said 57 percent of improper Medicaid payments result from errors as opposed to fraud, Forbes reported. In light of this, "reliance upon inaccurate data and flawed methodology can result in innocent participants in the healthcare system being exposed to expensive, lengthy, and potentially ruinous audits and investigations," the article cautioned.

Another information integrity problem stems from intentional corruption of health records or data by providers on the investigative hot seat.

Ted Radway, an assistant U.S. attorney for the District of Columbia, warned FierceHealthPayer: Anti-Fraud about cases where unscrupulous providers throw "charting parties," for example, to alter, destroy or fabricate medical records. Typically this happens in response to a subpoena or payer audit.

A related problem recently came to light involving the beleaguered U.S. Department of Veterans Affairs. Data integrity problems emerged after audits of patient wait times at VA medical facilities, according to The Washington Examiner. Specifically, the agency's "secret waiting lists" concealed that about 1,500 ailing veterans had waited months to see a doctor, as FierceHealthcare reported. VA leadership promised to discipline staff who falsified the agency's numbers, The Examiner added.

For more:
- here's the Forbes article
- read the Washington Examiner article