By skyforbes Welfare Moms go to Jail while $100+ million Contractors are free to Commit Fraud
Over the past 20 years, Texas has privatized computer systems and call centers for its Medicaid program to contractors, including IBM, Accenture (formerly Andersen), Electronic Data Systems, (currently HP), and Xerox. Accenture’s contract alone was for $899 million. In 2006, IBM received a $869 million contract in 2006. In 2008 IBM’s servers crashed which compromised Medicaid fraud investigations. The private contracts have been a disaster for residents of Texas that receive benefits. Delays, misinformation, and denial of coverage are just the tip of the proverbial iceberg.
While many influential people are heralding the potential of Big Data in solutions across multiple industries including healthcare, lack of domain expertise and oversight will destroy any big data deployment. Many of the bungled Texas Medicaid contracting disasters could have been prevented with competent checks and balances.
Surprisingly, after IBM’s server debacle in 2008 Texas paid the majority of IBM’s contract and transferred the contract to Capgemini and Xerox. Xerox was fired by the Texas Health and Human Services Commission charging that Xerox paid hundreds of millions of dollars in rubber stamped Dental Claims.
Headlines are made across the country documenting prison sentences for Medicare and Medicaid providers and recipients that defraud the State and Federal healthcare programs. Doctors, dentists, chiropractors, and home health administrators are found guilty of Medicare and Medicaid fraud on a daily basis. Very rarely do you find contractors going to prison for fraudulent activities in the deployment and operation of State Medicaid contracts.
Existing technologies and data sets can keep tabs on contractor performance in Medicaid and Medicare contracts. These systems can prevent fraud and increase the quality of care in Medicaid and Medicare services.
Texas attempted to rein in Medicaid fraud and recently hired a small technology firm, 21CT. The no-bid contract worth $110 million was a project utilizing big data to visualize healthcare fraud. The company utilized healthcare claims databases to identify potential Medicaid fraud. Rampant fraud at the company hired to identify fraud has been alleged by Texas Health and Human Services and an FBI investigation is reportedly under way.
The data gathered by mobile health technologies including patient monitoring and sensors provide a means of increasing quality of care and identifying healthcare fraud. Incremental inclusion of mobile health data sets into big data analysis will be a benefit to patients and prevent Texas sized healthcare frauds committed by vendors and contractors.