• Washington Lawmaker calls for State Medicaid System to Detect Fraud BEFORE payments, opposed by usual suspects

    February 7th, 2012 by admin Categories: Blogs Tags: , , , , , , ,

    Just like most states including California, Washington bases it Medicaid fraud prevention on a “pay and chase” model, instead of utilizing new technology analytics to detect fraud before paying out claims. It could save millions, in Caifornia billions, but like California, the Washington agency bureaucracy responsible for managing the system claims they are already doing enough. Hardly, but this is the classic example of resistance commonplace when it comes to getting serious about preventing government payment fraud. TechLeader.TV wishes Republican Sen. Jana Holmquist well in her quest for reform. Here from Molly Rosbach in the Yakima Herald-Republic:

    Lawmaker says Medicaid payment system is broken, need to shift from state’s “pay-and-chase” way of paying Medicaid claims first and then looking for fraud to what she says is a “prevention and detection” model that would be more effective… But Sen. Jana Holmquist Newbry, R-Moses Lake, has yet to convince those would have to implement the measure, the state Health Care Authority.

    Holmquist Newbry, through Senate Bill 6466, seeks to shift the state’s “pay-and-chase” way of paying Medicaid claims first and then looking for fraud to what she says is a “prevention and detection” model that would be more effective.

    The bill could save the state $5 million to $20 million a year, Holmquist Newbry said, and represents a way for legislators to be “good stewards” of taxpayer money while trying to close the state’s $1 billion budget deficit.

    “Bottom line, instead of just continually asking the taxpayers for more money and telling them to trust us, we should change the way we’re doing business,” Holmquist Newbry said in a telephone interview Friday.

    The Health Care Authority already has several methods besides “pay-and-chase” to ensure that payment is legitimate, said Jim Stevenson, agency spokesman. For example, providers are periodically audited and computer programs detect suspicious billing patterns are just a few, he said.

    Cathie Ott, chief information officer for the Health Care Authority, say these techniques already catch fraud. Although Holmquist Newbry says her bill would not have a fiscal impact because savings would pay for a new computer system, Ott said there would be a “substantial” expense to implement. Ott said the legislators might be falling for a sales pitch without having all the relevant information.

    Already doing it and new system would be too costly. Typical alibis. GAO and others say medicaid 10-20%, even 30% fraud, but folks like Ott refuse to remove the blinders. Is California doing any different? See here.

    Here’s whole story from Washington State.



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