A while ago I mentioned that government medical billing software has
inadequate controls to protect against fraudulent or invalid billing
attempts. I wasn't exaggerating.
From a news report:
New York State "Comptroller Tom DiNapolis office has released
<http://blog.timesunion.com/capitol/archives/178480/audit-flaws-in-doh-system-allowed-7-8m-in-medicaid-overpayments/http://osc.state.ny.us/audits/allaudits/093013/11s9.htm>an
audit showing the state Department of Healths Medicaid program overpaid
health care providers by $7.8 million over a six-month period due to flaws
in the eMedNY computer system. OSC auditors recovered about $7.5 million of
that sum.
This audit arrives the same day the U.S. House is slated to vote to accept
<http://blog.timesunion.com/capitol/archives/178480/audit-flaws-in-doh-system-allowed-7-8m-in-medicaid-overpayments/http://www.timesunion.com/local/article/U-S-begins-new-audit-as-Cuomo-tries-to-deal-with-4247643.php>a
scathing report on New Yorks Medicaid system an analysis that could lead
to a federal audit of the program.
...
As weve seen in previous audits, improvements are sorely needed in the
eMedNY system, DiNapoli said. DOH could have prevented most of the
overpayments with better controls. DOH needs to make sure these
overpayments dont continue. Millions of dollars are being wasted.
DOH administers the states $54 billion Medicaid program. Its eMedNY
computer system processes Medicaid claims submitted by providers for
services rendered and generates payments to reimburse the providers for
their claims. During the six-month period ended September 30, 2011, eMedNY
processed approximately 178 million claims totaling $25 billion.
DiNapolis auditors found that about $6.4 million of the overpayments were
attributable to 14 claims which had excessive amounts for coinsurance,
copayments, or deductibles from other plans. Most of this was attributable
to one overcharge of $6,171,957 wherein a provider inadvertently posted a
date into the field designated for the amount of a copayment."
My state paid umpteen millions of dollars for this software, and the
programmers apparently didn't even know how to do elementary validation of
data input to make sure that a date value can't be saved into a money
field. Sheesh.
I am not a professionally trained programmer, and I will bet you that the
people who created this software are. So much for professional training.
And this also argues in favor of database software (like VFP) that has
unique date data types that can't be confused with anything else.
Ken Dibble
www.stic-cil.org
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