By Adam Decker, Marketing −
Each year the federal government loses billions of dollars to individuals who fraud the Medicaid system.
Recently officials began implementing measures to strike back at Medicaid fraud. They teamed up with a company out of Austin, Texas called 21CT to put an end to Medicaid scams once and for all.
Taking Fraud Down in Texas
Texas accounts for over $2 billion a year in Medicaid losses, so it makes sense to start there to test out a solution to the problem. 21CT’s cure-all for Medicaid fraud: a computer program called Torch.
Although officials won’t get into specifics on the program, not wanting to give those committing fraud a clue on how to avoid getting caught, they did give an overview of what appears to be an impressive, thorough system.
How Torch Detects Fraud
Program creators designed Torch to run on a computer 24×7. It gathers pertinent data related to doctor visits, claims, payments, patients, and more. Every time someone use a Medicaid account, Torch will identify it, see why it’s being used, and finally determine if the claim in genuine through various factors, such as the type and frequency of the claim.
The system looks for red flags and then alerts the operator of potential fraudulent claims.
Medicaid fraud is neither simple nor straightforward, and neither is this system. Currently 21CT employs over 100 people to sift through the massive amounts of information, with more data coming down the pipeline. They need as many people as possible to sort through this data and find any suspicious activity.
Out With the Old
Previous systems used to detect fraudulent activity were not successful because they did not run smoothly or efficiently. Often times, the operator would have had to constantly switch from one screen to another to view results or data. With Torch, everything is on one screen. If someone needed additional information, there are multiple tabs on the same screen, making Torch easy to use.
If successful, Torch could make a big difference in fighting Medicaid fraud. Only the basics of the system have been released to protect its integrity and make it a viable way to combat this serious problem. The government is hopeful Torch will go a long way in solving the problem.
Another emerging technology with the potential to seriously cut into fraudulent transactions is EyeDetect™. This non-intrusive, lie-detection technology tracks eye movement to determine with 85 percent accuracy the truthfulness of examinees.
In reality, EyeDetect could be used to screen people applying for Medicaid benefits to determine if they are attempting to deceive Medicaid personnel in order to receive extra benefits. This technology has the potential to uncover attempted fraud, even before users get started with the Medicaid system.