I have written about the Cray computer technologies at CMS before and actually this is bigger fraud news than the release of all the doctor claim data, well that is except for the media as they want to do analytics and write data stories with “interviewing data bases”. Shoot we see technology replacing jobs all over the place and certainly hospitals would love to see these folks go as it makes for a lot of extra work when a properly configured CMS data appliance can make short work of it. Read further and see Mayo’s already using this technology as well.
Cray Computers Making a Big Comeback Thanks to Big Data–CMS Using Cray YarcData Unit To Detect Fraud Patterns With Payments
Here’s a short paragraph on the appliance and it is hot stuff as Oracle is coming out with an appliance too that can be used for data mining.
“YarcData’s graph analytics appliance Urika™ allows for real-time data discovery, enabling complex ad hoc queries against unoptimized datasets without compromising performance or redesigning data warehouses. Now you can discover hidden or unknown relationships in all your data: uncover new trading strategies, determine counter-party risk, identify insider trading, or expose new forms of cyber-attack.”
The YarcData unit is helping the U.S. government detect fraud patterns in Medicare and Medicaid payments. Private sector customers include medical research group Mayo Clinic and several financial services, life sciences and telecommunications firms, which Cray cannot name for contractual reasons.
When you look at the numbers here with about half of the auditor payment denials being appealed and 72% work out in favor of the hospitals, it’s like is it time to ask “what we are doing here” as one questions a return on investment and if the Cray Yarcdata does this, well who needs the RACs? Perhaps a good question to ponder.
I don’t know how far along they are with the mobile interface but certainly we know the other side is working already as law enforcement agencies have made arrests already as the patterns identified with the data made potential fraud folks visible.
The American Hospital Association is pushing its members to lobby U.S. senators to pass a bill introduced last year that tweaks the way Medicare recovery audit contractors do business.
Hospital executives will be descending on Capitol Hill on May 7 as part of an annual AHA-coordinated day with their local representatives and staffers to discuss the most pressing regulatory matters for hospitals.
Chief among concerns detailed during a May 5 federal issues panel at the trade group's annual conference was what AHA sees as the increasingly burdensome behavior of RACs as they seek instances of Medicare overpayment.