By Taylor Smith, Marketing —
What would you do for 30 billion dollars? What would you do to prevent having a 30-billion-dollar bill in your name? Regardless of the extent you would go to avoid that, the State of Illinois paid around that amount last year for Medicaid and Medicare payments that turned out to be fraud. According to a report from the Health Care Fraud Elimination Task Force erroneous and significant amounts of money have been paid out do doctors, nurses, and other medical providers who have been falsifying claims made to Medicare and Medicaid for payment. By sending in false billing codes, by conspiring with a patient to drive up bills, or by sending in procedures and tests done in one visit as if they were done separately these people are able to drive up the total cost of care and rake in, well billions.
Currently there are standards and limitations that allow or disallow providers to participate in Medicare or Medicaid. Often these are based on drug use, previous fraud, and other criminal or unprofessional behaviors. Anyone who does not pass this screening is placed on probation for a time or for good depending on the severity of their behavior.
With such a significant sum of 30 billion dollars, it seems that greater effort would be enacted to prevent providers who are likely to participate in fraud from dealing with State paid health care at all. In the past, other work has been done with police forces to track numbers and locate areas likely to be fraud. But in reality there is a simple solution.
EyeDetect would be perfect not only for verifying that fraud has been committed by a particular provider, but it would allow a credibility test for those providers who are working with Medicare and Medicaid. If they don’t pass this credibility screening which could test intent and history of committing fraud it would decrease the number of dishonest individuals with whom Medicare and Medicaid conduct business. In addition, this information, as gathered by the state would help consumers to potentially know which doctors had the highest financial trust. In short, this simple solution could save Illinois, and certainly many other states a significant portion of that 30 billion dollars.