New Database Software for Combating Medicare Fraud{2}


by Jennifer R
The author talks about the two Medicare fraud busts that went down in October 2010, where the Federal Bureau of Investigation arrested a large group of people attempting to defraud Medicare. The first group involved 55 people, with a fraud attempt of 163 million dollars; the second tried to defraud the system of 200 million dollars. Most of the money had already been paid out by the time the busts went down, making recovery highly unlikely. Medical fraud is costly to the government – the author says “there was an estimated $47 billion in improper Medicare payments in 2009 alone”. The government is trying to come with solutions to this problem, which is exacerbated by the size of the current system. One solution mentioned was to create a single database out of the individual government health-care databases, with the assistance of Teradata, a database-software company. The other solution proposed was a geographical information system, for tracking the patient movement for treatment within and between states.

We discussed in class the different types of entities that make up a database. I am curious as to how the government would set up entities in a fraud database. I would also like to know how they would decide what meets the criteria for fraud. When I first skimmed the article, the geographical information system caught my attention. I had no idea you could track fraud just by how often a patient does follow-up visits or where they travel for treatment. The article does say that “fraud investigators already use postal codes to identify suspicious claims”. I supposed keeping track of the places they receive treatment would help the government determine whether medical services were actually received.

 

Source: Westly, E. (2010). Computers Key to Fighting Medicare Fraud. IEEE Spectrum. Retrieved April 22, 2012 fromĀ http://spectrum.ieee.org/biomedical/ethics/computers-key-to-fighting-medicare-fraud