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Pennsylvania Human Services Department to Increase Payment Data Analysis

In the fall, the department plans to solicit ideas on how it can use data analysis to track provider payments and identify patterns that warrant investigation.

(TNS) — Call it Moneyball for Medicaid. Ted Dallas, secretary of the Pennsylvania Department of Human Services, wants to improve his agency's efforts to block improper and fraudulent payments by using sophisticated data analysis.

"Too much of what we do is manual. It's paper-based; it's cumbersome," he said, referring to making sure beneficiaries and service providers comply with regulations.

"If we can get technology to do some of those things, I think there is savings there over time, but I also think it frees up staff to do so some of those higher-value things that human beings do that can help people find a job, help people get an education, help get them out of poverty," Dallas said.

The DHS, which administers medical assistance benefits and other programs, said it avoided or recovered $582 million in improper payments in the year ended June 30.

Nearly three quarters of that amount, or $431 million, was money paid to health care and other providers, rather than the department's 2.8 million beneficiaries, the DHS said. The agency had a $31.8 billion budget in fiscal 2015, including $11.4 billion from the state and $17.6 billion from the federal government.

In the fall, DHS plans to solicit ideas from prospective data management contractors on how it can use data analysis to track provider payments and identify patterns that warrant investigation.

The agency also said it planned to automate additional processes, including what it called "identity proofing" of beneficiaries, provider enrollment, and the updating of its records to reflect milestones that can trigger changes in benefits, such as a child reaching a certain age.

Also, the agency will create a Web portal to improve its collections of money from other forms of insurance that medical assistance beneficiaries have. Collections of such third-party liabilities - now processed manually - were up 17.5 percent last year, to $94 million.

©2015 The Philadelphia Inquirer, Distributed by Tribune Content Agency, LLC.