Article - July 29, 2008 - Government Health IT

Senate Republicans talk Medicare anti-fraud fixes

By John Pulley

Senate Republicans signaled on Monday a willingness to consider private-sector IT solutions to massive fraud that, according to Sen. John Cornyn, (R-Texas), is “helping to drive Medicare into bankruptcy.”

At a forum intended to draw attention to the problem, an executive of LexisNexis told members of the Senate Republican Conference Committee that the “government lags behind in adopting commercially proven solutions” that have long been embraced by the private sector.

Medicare provides health insurance for more than 42 million disabled and elderly people. Inadequate controls and the sheer size of the program — it processes more than 1 billion claims annually — has made it highly susceptible to scams. By some estimates, 20 percent of the program’s annual $400 billion in payments are fraudulent.

“The commercial sector has adopted aggressive practices to curb these types of abuses in the financial services, insurance and collections industries,” said Haywood Talcove, chief executive officer of the Special Services division of LexisNexis, a global publisher and information provider owned by Anglo-Dutch publishing giant Reed Elsevier.

“The government must do more to leverage commercially proven solutions to help stop the hemorrhaging Medicare is experiencing,” Talcove added.

To prove his point, Talcove shared with senators the result of a pilot program his company undertook with the cooperation of the Centers for Medicare and Medicaid Services. Using a database of 248 million claims filed during a four-year period in Illinois and Washington state, LexisNexis cross-checked that information against its public-record databases for medical licenses, criminal convictions, professional sanctions and death records.

Full story


Page Information

  • 5 months ago [history]
  • View page source
  • You're not logged in
  • No tags yet learn more

Wiki Information
Update to PBwiki 2.0

An entirely new PBwiki experience, including folders and easier editing.

Convert Now for Free | Learn more