The company and subsidiaries are integrated in many areas and here’s one more with business intelligence and algorithms. As a refresher here, Ingenix is the company that settled with New York State on using a data base that created balance due billings for many in New York with an inflated customary charge algorithm calculation and this contract is to help the state of Washington fight fraud and is being paid for from a grant from CMS. No wonder these folks had record profits on the 2nd quarter, one contract after another.
Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care
OLYMPIA, Wash., and EDEN PRAIRIE, Minn.--(BUSINESS WIRE)--The Washington State Department of Social and Health Services (DSHS) has awarded a $19 million, five-year contract to fight and prevent Medicaid fraud, waste and abuse to Ingenix, a leading information, technology and consulting services company.
Washington’s initial investment in the contract is funded by a $5.9 million Medicaid Transformation Grant awarded by the federal Centers for Medicare and Medicaid Services (CMS). The Washington DSHS grant application to CMS outlined the goal of creating a second-generation fraud and abuse detection system that would bring together “the tools, resources, and comprehensive approach for detection and prevention of fraud, waste and abuse…[that would establish] a national model for Medicaid payment integrity.” Over the course of the new contract with Ingenix, Washington expects to recover contract costs in the first year of operations, with an increasing return-on-investment ratio over the life of the contract, expected to be no less than three-to-one.
Using Ingenix rules-based algorithms, peer group models, data analysis tools, and provider self-review functionalities, DSHS was able to identify, prevent, and/or recover inappropriate payments to health care providers.