Government Technology
Government Technology: State & Local Government News Articles

Tiny Little Rip-Offs



Print
Comment

Jun 3, 2008, By Emily Montandon, Associate Editor

I suspect one of my relatives is being taken advantage of by her doctor. In fact, I think most Americans are being taken advantage of by this relative's doctor.

After sticking to a healthy lifestyle for most of her life, she doesn't worry anymore about certain aspects of her health. Her doctor tells her she should take cholesterol medication, but she refuses. In fact, she stubbornly turns down medication for almost everything. Even so, her doctor administers costly in-office tests at every monthly check up - even when my relative has already refused to take action based on the same tests at previous visits.

After accompanying her to see this doctor and hearing from other family members who have accompanied her, it seems the doctor - who specializes in care for the elderly - cares as little about these test results as my relative. I can only assume the tests are being ordered simply as a mechanism for regular billing. Unfortunately a few extra dollars in the doctor's pocket - and other pockets like his - is costing us all a lot of money.

For the most part, my relative never sees a bill for these tests. The government pays the majority of the costs, and a secondary insurance provider picks up the rest. When an explanation of benefits arrives in her mailbox, she often doesn't remember what it's for.

As more people begin to see government programs, such as Medicare and Medicaid, as opportunities to increase their own wealth, these tiny little rip-offs add up to a big drain on the health-care system, state budgets and our economy as a whole.

Because fraud and abuse often go undetected, it is hard to determine exactly how much public money is paid out to unscrupulous billers and undeserving recipients. The National Health Care Anti-Fraud Association estimates that more than $60 billion per year is wasted on fraudulent claims across the health-care industry. And as the federal government tightens Medicaid spending, it's incumbent on states to make the most of the remaining dollars.

In this issue, Features Editor Andy Opsahl shows how some state governments use IT to ease the cost challenges associated with government health programs.

One particularly interesting case comes from California, where the state uses technology to spot Medicaid abusers and stay ahead of the fraud game. While automation reduces costs of billing processes for government programs, it also opens the door to a new breed of crooks who repeatedly bill for services they know will be automatically approved.  

Using predictive analytics, California not only identifies fraudulent Medicaid billers, but also discovers new fraud patterns as crooks learn how to avoid the old pitfalls.

With numerous other economic woes beating down on the economy, the spotlight on health care has dimmed slightly in the public eye. But long-term, everyone knows the health-care crisis must be addressed, and states are looking to technology to reduce its impact now and in the future.


If You Liked This Article, You May Also Like...


Latest Government Technology News


Industry Solutions for Government

Read real world deployments of technology in government from our sponsors.

View All Industry Solutions

Related Products and Services

Marketplace



This section
brought to you by:


Mobile Communications Survey Executive Summary

More than 200 responses were captured to help gauge the effectiveness and types of communications and situational awareness capabilities currently deployed for emergency response. View the Executive Summary Now!

Dispatch Operations and Interoperability

A New Era in Public Safety BlackBerry® smartphones running on Sprint networks deliver a wide range of applications that are transforming public safety operations.


Hurricane Preparedness Tips When a hurricane hits, are you prepared to keep in touch?


Case Study - Morris County, New Jersey The Morris County Communications Center upgraded to a new trunked radio system with the benefits of a cellular network, extending coverage beyond county lines


Case Study - Iredell County, North Carolina Spanning over 570 sq miles, it became imperative that the Iredell County Emergency Communications, Operations and Management extend it's communications systems to enhance reliability, security, and coverage.


Case Study - City of Anaheim, California The City of Anaheim saw an opportunity to leverage existing GST and partner with nearby cities to enhance safety operations through data interoperability.


Case Study - Charlottesville, Virginia Fire Department Taking advantage of a range of interoperability solution, the Charlottesville Fire Department has achieved a network that can serve as backup to their existing public safety network.


Sprint ERT Go-Kit with GST Optima Rapid, interoperable communications for emergencies, drills and field exercises.


Optimal Interoperability Until recently it was not possible to cost effectively connect commercial networks to LMR systems. Improvements in communications technology have resulted in greatly enhanced operational capability and have reduced the log-term cost of communications system ownership.


Multi-agency interoperability for Public Safety Establishing cross-agency, real-time situational awareness is critical to effective incident management as well as daily resource management.


Video


DHS Grant Links

DHS Grants and Assistance Programs Link to overview of available grants administered by The Department of Homeland Security (DHS)


Fact Sheet: Fiscal Year 2008 Preparedness Grants Major changes in funding and focus for 2008 DHS grant programs


Remarks on 2008 Homeland Security Grant Guidance DHS Secretary Michael Chertoff and FEMA Administrator David Paulison


$1.8 billion in DHS Homeland Security Grant Program Awards


Funding Public Safety Communications Whether you are a law enforcement agency, looking for funding to support an interoperable communications solution or a school, seeking to improve communications between building administrators, grants may provide the funding you need to implement a robust, scalable communication system.


Yes! I would like more information about Sprint's dispatch operations and interoperability solutions.