From what I am reading here, this somewhat makes a case for some better software and is part of the reason I think that private industry has had a leap on securing some of this type of business, like in the State of Washington and now we have insurance company interests engrained in government operations even tighter.  Ingenix has quite a few contracts of such.

State of Washington Awards Contract to Ingenix (Subsidiary of UnitedHealthCare)

Private industry may have better software for detecting, but can we trust them?  This makes me think back to Ingenix and all the emerging lawsuits over the data base that was declared illegal and fought by the Attorney General of New York for sending more fees back to patients to pay.

Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care

Do you hand out contracts to companies that lost battles in court over illegal transactions and is this how they get awarded due to government failures either with their own software or contract problems?  BD 

Ingenix data base has some long reaching legal tentacles with ...

GOSHEN — Two years ago, Orange County enlisted three firms to scour medical billing records and help recover an estimated $2 million per year misspent in the single largest expense in the county budget, Medicaid.

By this time, county officials planned to have audited 25 businesses they targeted through an initial screening of Medicaid bills.

But to date, only two audits have been done, no funds have been recovered and the future of the investigation is uncertain.

But after contracting with two law firms and an accounting firm to conduct the work, Orange County officials grew so frustrated with the state's oversight that they effectively quit the program in 2008 to audit providers on their own.

Medicaid fraud demo program falters in Orange |


  1. I'm not sure we can trust private or public at this point.

    J. Ryan
    Medical Billing Specialist

  2. I agree, who can we trust and thus a need to run audit trails on a regular basis and/or have the insurance companies submit their algorithms for certification just like the EHR software people do.

    It's getting harder to live in the world of the unknown today with money being so tight. When I went to the World Medical Tourism conference that was one thing I noticed they could all do, quote price, and it really was the price you would pay.


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