On 2/14/2013 2:05 PM, Ken Dibble wrote:
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 DiNapoli’s 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 Health’s 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 York’s Medicaid system an analysis that could
lead to a federal audit of the program.
...
“As we’ve 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 don’t continue. Millions of dollars are being wasted.”
DOH administers the state’s $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.
DiNapoli’s 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.
Thanks for sharing, Ken. I'm going to show this to my peers here at the
day gig. We do audits on Medicaid payments to providers in some states
(but not New York!) and the main app is a VFP app.
--
Mike Babcock, MCP
MB Software Solutions, LLC
President, Chief Software Architect
http://mbsoftwaresolutions.com
http://fabmate.com
http://twitter.com/mbabcock16
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