Ok that was just on Monday I posted about the disappointment with fraud prevention and I guess it has earned this this bit big of business, is this all there is to this? I realize the contractors have the data but like commercial insurance carriers do they run the work to a 3rd party a lot of time. Usually the software used for anti fraud comes from subsidiaries of commercial insurance companies like Ingenix, a subsidiary of United Health Group and I’m sure their software is in the mix here too, so more transaction profits for those folks.
Medicare Fraud Prevention Has Cases Falling Through the Cracks–Looks Who’s Getting the Contracts And Check Out the Algorithms For Their Profitable Business Models
When you look at the site under Part A you can clearly see Wellpoint as a huge administrator for many of the states, so in case you were not aware here’s another area of integration with health insurers and the administration through contractors and I am adding this as information so to create an awareness of where and how companies function today so you can see the tie ins with Medicare contractors. It is a bit shocking to see a contract for Congressional Contacts have a Wellpoint email address I must say, so what kind of an office is this you might ask?
In essence the contract looks like a win for Well Point as a partner with this contractor for Medicare so again we have transaction fees that enter into the picture here and hopefully Wellpoint does this in house and doesn’t outsource their part of the Medicare Contractor business. Today in the news another Blue Cross Office unrelated to Medicare announced their new outsourcing solution.
To get right down the the bottom here, this clearly shows how the US Government is lacking with technology and Health IT capabilities to not be able to do this in house. It’s a big catch up game. Just this week Wellpoint made their commitment to HIT and with what appears to be a lot of business on the line here with this contractor, it was the politically correct thing to do.
WellPoint Joins Meaningful Use in HIT–It’s the Politically Correct Thing To Do With Pay for Performance Algorithms For Analysis
One other big issue that hurts the government from increasing internal infrastructure was this move out of the Senate, which shows they just don’t get it as Web and Cloud work together, so they approved one and not the other, duh? Do pay close attention to items as such as those are the folks that somehow rationalize their thoughts to make law? It scares me and the reasoning here for not approving is due to lack of proper and detailed guidance” with the Cloud. Proper guidance these days is not stopping anyone from running for office though <grin>.
Senate Cuts Cloud Services From Budget That Would Allow for Data Center and IT Infrastructure Consolidation–Back to the 8 Track Tapes Next?
Anyway, so much for my rant but again the big contracts for those that were in the news for not fighting fraud….hmmmmm…we really need people that can make sense out of some of this and have good consumer digital IT and Health IT knowledge in these places, otherwise I guess I’ll have more posts like this. The Government needs some good coders internally working. BD
To support its efforts, CMS recently awarded a $5.5 million five-year contract to National Government Services Inc., a large Medicare contractor in 20 states, to assist in preparing and processing incentive payments beginning in fiscal 2011.
The services will help ensure the proper accounting of the payments to eligible physicians and hospitals under the HITECH Act, according to CMS.
The agency has estimated that up to 50,000 physicians and more than 2,000 hospitals will participate in the first year of the meaningful use program.
Indianapolis-based National Government Services will develop software to create provider incentive payment files, prepare the files to prompt payment and track the payments.
Data will flow into this system from CMS’s National Level Repository (NLR), which will contain healthcare providers’ registration for incentive payments, documents verifying their eligibility and banking information for each recipient.
Other CMS’s Medicare administrative contractors will supply supporting information about participating Medicare providers, such as their identification numbers, banking information and medical claims payments history.