Instrumented Interconnecteds Intelligent

Posted by
Guest in

Post feed

RSS 2.0

by Secretary Al Delia, North Carolina Department of Health and Human Services 

Twelve billion dollars.

That’s the price tag for providing vital Medicaid services to 1.5 million North Carolinians. That kind of money is crucial for so many of our citizens in need, but the complexity of the system combined with such large sums of money also present an unwelcome opportunity for fraud, waste and abuse. Every year, Medicaid suffers losses at the hands of people intent on defrauding the system, and it’s potentially costing us millions in taxpayer dollars.

YouTube Preview Image

As governor during the worst economic crisis North Carolina has seen since the Great Depression, Governor Bev Perdue made it her mission to fix state government – making it work smarter for our citizens by doing more with less. Hundreds of millions in state dollars were cut from our Medicaid budget in the last three years, and that meant making choices that were almost unbearable. Do we deny coverage of prosthetic limbs, or dentures? Do we cancel payment of vaccinations for children, or eye care for the elderly?

With Governor Perdue’s leadership and unwavering commitment to accountability in state government, we made the tough choices while protecting services for as many as possible. But even as we stretched every dollar and pinched every penny, we knew unscrupulous people were still finding ways to game our system, and it added insult to injury. Every dollar wasted or defrauded could be used to provide much-needed care to a child or a disabled person. Something had to change.

So in 2010, under the governor’s direction, the state Department of Health and Human Services partnered with IBM for a software system designed to ferret out fraud, waste and abuse in our Medicaid system. North Carolina is the first state to use IBM’s advanced analytics in this way, and now, two short years later, we are on the cusp of a dramatic crackdown on what appears to be widespread defrauding of Medicaid.

In just our first phase of data analysis, we’ve flagged hundreds of providers who have submitted bills for hundreds of millions of dollars in suspicious claims. The beauty of this system is that it recognizes patterns of billing behavior that don’t fit in with the norm – and then takes it a step further by looking for relationships among providers that can point us to a web of suspicious accounts. With some 88 million Medicaid bills coming in every year, there’s no way we could connect these dots through manpower alone. Analytics makes it possible to sift through tens of thousands of documents and hundreds of millions of pieces of data to identify strange behavior in a matter of minutes.

This summer DHHS investigators are fanning out across the state to put together criminal cases, and the state attorney general is ready to prosecute. Word is getting out to unscrupulous Medicaid providers: the state is watching your every move.

It’s about to get a whole lot harder to steal money from the state of North Carolina.

Now that’s smarter government.

Bookmark and Share

Previous post

Next post

5 Comments
 
December 13, 2013
8:57 pm

88888 We are undecided when they are sufficient to stop a pedicab driver, but we haven’t but placed much of our self esteem inside their arms.. Web TutorialsLet’s facial area it, a great number of of us don’t provide the time or cash flow make use of hair dressers, louis vuitton boat shoes makeup artists and stylists on even an occasional foundation.
Christian Louboutin Shoes Sale USA http://www.cheapclonusa.com


Posted by: Christian Louboutin Shoes Sale USA
 
December 13, 2013
8:48 pm

88888 We are unsure should they be sufficient to stop a pedicab driver, but we have not yet put a lot of our self esteem of their fingers.. On the internet TutorialsLet’s encounter it, numerous of us will not possess the time or finances to utilize hair dressers, artsy gm louis vuitton bagshop louis vuitton belts makeup artists and stylists on even an occasional basis.
Christian Louboutin usa http://www.cheapclonusa.com


Posted by: Christian Louboutin usa
 
December 13, 2013
8:06 pm

88888 We are unsure should they be good enough to prevent a pedicab driver, but we haven’t nevertheless positioned a lot of our self esteem within their fingers.. Via internet TutorialsLet’s deal with it, loads of of us will not possess the time or wealth to make use of hair dressers, louis vuitton blue purse make-up artists and stylists on even an occasional basis.
sale nike free run shoes http://www.freesportsonsale.com


Posted by: sale nike free run shoes
 
October 27, 2013
11:47 am

It’s truly very complex in this active life to listen news on TV,
therefore I just use internet for that reason, and obtain the most recent information.


Posted by: http://audioboo.fm/
 
July 7, 2013
1:25 am

In common speech, ‘vaccination’ and ‘immunization’ have a similar meaning. This distinguishes it from inoculation, which uses unweakened live pathogens, although in common usage either is used to refer to an immunization. “,-*

With best regards <http://www.healthdigest101.com/


Posted by: Meryl Elsey
 
2 Trackbacks
 
May 25, 2012
2:08 am

[...] "The beauty of this system is that it recognizes patterns of billing behavior that don’t fit in with the norm—and then takes it a step further by looking for relationships among providers that can point us to a Web of suspicious accounts," Al Delia, North Carolina DHHS acting secretary, wrote in an IBM blog post. [...]


Posted by: IBM Predictive Analytics Helps North Carolina Detect Medicaid Fraud | China Battery Products
 
May 24, 2012
3:39 pm

[...] “The beauty of this system is that it recognizes patterns of billing behavior that don’t fit in with the norm—and then takes it a step further by looking for relationships among providers that can point us to a Web of suspicious accounts,” Al Delia, North Carolina DHHS acting secretary, wrote in an IBM blog post. [...]


Posted by: IBM Predictive Analytics Helps North Carolina Detect Medicaid Fraud » Techno Capital
 
Post a Comment