On Thu, Feb 14, 2013 at 1:05 PM, Ken Dibble <[email protected]> wrote:
> A while ago I mentioned that government medical billing software has > inadequate controls to protect against fraudulent or invalid billing > attempts. I wasn't exaggerating. > > From a news report: > > New York State "Comptroller Tom DiNapoli’s office has released < > http://blog.timesunion.com/**capitol/archives/178480/audit-** > flaws-in-doh-system-allowed-7-**8m-in-medicaid-overpayments/** > http://osc.state.ny.us/audits/**allaudits/093013/11s9.htm<http://blog.timesunion.com/capitol/archives/178480/audit-flaws-in-doh-system-allowed-7-8m-in-medicaid-overpayments/http://osc.state.ny.us/audits/allaudits/093013/11s9.htm>>an > audit showing the state Department of Health’s Medicaid program overpaid > health care providers by $7.8 million over a six-month period due to flaws > in the eMedNY computer system. OSC auditors recovered about $7.5 million of > that sum. > > This audit arrives the same day the U.S. House is slated to vote to accept > <http://blog.timesunion.com/**capitol/archives/178480/audit-** > flaws-in-doh-system-allowed-7-**8m-in-medicaid-overpayments/** > http://www.timesunion.com/**local/article/U-S-begins-new-** > audit-as-Cuomo-tries-to-deal-**with-4247643.php<http://blog.timesunion.com/capitol/archives/178480/audit-flaws-in-doh-system-allowed-7-8m-in-medicaid-overpayments/http://www.timesunion.com/local/article/U-S-begins-new-audit-as-Cuomo-tries-to-deal-with-4247643.php>>a > scathing report on New York’s Medicaid system an analysis that could lead > to a federal audit of the program. > ... > > “As we’ve seen in previous audits, improvements are sorely needed in the > eMedNY system,” DiNapoli said. “DOH could have prevented most of the > overpayments with better controls. DOH needs to make sure these > overpayments don’t continue. Millions of dollars are being wasted.” > > DOH administers the state’s $54 billion Medicaid program. Its eMedNY > computer system processes Medicaid claims submitted by providers for > services rendered and generates payments to reimburse the providers for > their claims. During the six-month period ended September 30, 2011, eMedNY > processed approximately 178 million claims totaling $25 billion. > > DiNapoli’s auditors found that about $6.4 million of the overpayments were > attributable to 14 claims which had excessive amounts for coinsurance, > copayments, or deductibles from other plans. Most of this was attributable > to one overcharge of $6,171,957 wherein a provider inadvertently posted a > date into the field designated for the amount of a copayment." > > My state paid umpteen millions of dollars for this software, and the > programmers apparently didn't even know how to do elementary validation of > data input to make sure that a date value can't be saved into a money > field. Sheesh. > > I am not a professionally trained programmer, and I will bet you that the > people who created this software are. So much for professional training. > > And this also argues in favor of database software (like VFP) that has > unique date data types that can't be confused with anything else. > ---------------------- > I think you are fooling yourself thinking that this is easy. They put in date data into an amount field. Sorry but that is just an oops in data entry, or in mapping. Should that value thrown a flag? Heck yeah. seems like they found only a few claims that were done this way. Those companies will not get checks for a while as their credit balance is worked off. -- Stephen Russell Sr. Analyst Ring Container Technology Oakland TN 901.246-0159 cell --- StripMime Report -- processed MIME parts --- multipart/alternative text/plain (text body -- kept) text/html --- _______________________________________________ Post Messages to: [email protected] Subscription Maintenance: http://mail.leafe.com/mailman/listinfo/profox OT-free version of this list: http://mail.leafe.com/mailman/listinfo/profoxtech Searchable Archive: http://leafe.com/archives/search/profox This message: http://leafe.com/archives/byMID/profox/cajidmy+jydhy4s0c7-v-qvanrg9a-sgq3dgq2z4_pfah+pq...@mail.gmail.com ** All postings, unless explicitly stated otherwise, are the opinions of the author, and do not constitute legal or medical advice. This statement is added to the messages for those lawyers who are too stupid to see the obvious.
