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. 

Andrew Cuomo – You Have to Like This Guy – Healthcare Reform

Will there be any transparency and will the data base and algorithms be set at the correct levels so the honest claims don’t get mixed in with any of the potential fraud?  BD  image

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.

State of Washington Awards Program Integrity Contract to Ingenix

Related Reading:

Corporate Wellness Programs Still Remain Illusive – The Back Side of Business Intelligence for Profit?

UnitedHealth Ingenix's acquiring AIM Healthcare Services in Tennessee

United Health Care Says Cheaper Efficient Doctors and Reducing Hospital Visits by the Elderly Would Help Reduce the Cost of Healthcare
I’m Stuck with United HealthCare – Would Welcome a Change to Try a Public Health Insurance Option
The Ingenix Inquisition – Hearing Requested by Senator Rockefeller
Andrew Cuomo – You Have to Like This Guy – Healthcare Reform
Prescriptions risk score used to deny health insurance


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