Although states are required to report their exclusion lists to the federal government, many have problems with technology and data formats and, as a result, it's easy for the criminals to move around and get payments in another state.
Austin, Texas (PRWEB) February 24, 2009
The three physicians and three health care workers arrested in Florida last week for allegedly defrauding Medicaid out of millions of dollars are still eligible to receive payments in any other state in the U.S. According to a comparative analysis conducted by S3 of Austin, Texas, which used sophisticated matching technology, none of the names of the six suspects appears on the federal exclusion lists and, consequently, they remain eligible to receive legal Medicaid payments, if they were practicing anywhere other than Florida.
"This case perfectly shows the problems confronting Medicaid and Medicare," said Andi Gillentine, Executive Vice President of Health Care for S3 and an expert on industry technology. "Although states are required to report their exclusion lists to the federal government, many have problems with technology and data formats and, as a result, it's easy for the criminals to move around and get payments in another state."
According to S3's analysis of state and federal exclusion lists for doctors and health care providers, no state has reported more than 50 percent of disqualified names to the federal database, with New Jersey sending less than 3 percent to Washington. The failure of states to effectively comply with the federal reporting law and outdated technological systems has created a huge gap to be stepped through by criminals.
"What we have right now is decades old web technology and a matching technology invented in 1920," added Gillentine. "A solution exists today that can keep other states from disbursing medicaid money to fraudulent providers in well under a year. And it can solve other problems related to the No Fly List and other types of fraud."
About S3 Matching Technologies - S3 is an Austin, Texas based company focused on providing business crisis solutions for network outsourcers, financial services, and healthcare industries. S3's software is deployed as a managed solution to solve time-sensitive business crises.