Systems in fraud fight ineffective

MIAMI – The federal government’s systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underused, making it more difficult to detect the billions of dollars in fraudulent claims paid out each year, according to a report released today.

The Government Accountability Office report said the systems don’t even include Medicaid data. Furthermore, 639 analysts were supposed to have been trained to use the system – yet only 41 have been so far, it said.

The Centers for Medicare and Medicaid Services – which administer the taxpayer-funded health care programs for the elderly, poor and disabled – lacks plans to finish the systems projected to save $21 billion. The technology is crucial to making a dent in the $60 billion to $90 billion in fraudulent claims paid out each year.

The current database is a piecemeal system with data stored in disparate systems, meaning employees don’t have access to all data from all programs.

Each state has its own systems with very limited access to Medicare or national Medicaid data.

The new $150 million systems, which went live in 2009, are intended be a one-stop storage for all data, accessible by all CMS staff and its contractors, law enforcement and state agencies.

But crucial pieces are still missing – including so-called “share systems data” that would help analysts identify and prevent payment of fraudulent claims, according to the report.