Medicare Fraud is Ripe for a Tech Solution, But It's Complicated

Scott Mace, for HealthLeaders Media , September 10, 2013

Adrian Gropper, MD is PPR's chief technology officer. He has a deep understanding of NSTIC's concept of the identity ecosystem. We spoke last week and I noted the irony that NSTIC faces challenges receiving further funding to solve the identity problem the right way, while at the same time H.R. 3024 proposes allocating $29 million for the Medicare Smart Card pilot.

Maybe these two government initiatives should get together and share expertise and funds, I suggested to Gropper.

"That's a very nice idea," Gropper told me.

Now before you write me, yes there are many other ways to fight Medicare fraud with technology other than figuring out the identity and smart card problems. Algorithms are already at work, and getting smarter, at detecting patterns of abuse. The Medicare regulations themselves probably still contain an encyclopedia's worth of loopholes that permit waste and fraud, loopholes that should be closed.

But in an age when libraries do a better job of protecting our privacy than healthcare does, and when the average wallet has an impressive array of security-powered smart cards, surely Medicare, and the rest of the healthcare system, can be doing better than it is.

Scott Mace is senior technology editor at HealthLeaders Media.
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3 comments on "Medicare Fraud is Ripe for a Tech Solution, But It's Complicated"

Frank Poggio (9/12/2013 at 2:57 PM)
Scott, Great post, good summary. As I have said on this blog and others, it is not a technical problem, but a political and sociological one. Till they get those resolved there can be no cost efficient or user friendly solution.

Randy Vanderhoof (9/12/2013 at 10:11 AM)
Solving the Medicare fraud problem is not that complicated. Much of what you reported I agree with, but I take issue with the threat to privacy concern that you mention. The Smart Card Alliance has published numerous reports that address the appropriate use of smart card technology for healthcare use. To begin with, the Medicare Common Access Card Act of 2013, aims to fix an existing privacy problem by taking the current personal identifier, you social security number, off the front of the card and storing it securely on the smart card chip that can only be read when the cardholder inserts it along with a PIN to an authorized terminal in a medical facility. Also, if the government wanted to extend services for home use, it could provide low cost (under $10) readers for home computers that would enable people to securely access their health records without entering their social security number on the keyboard and exposing it to hackers. A few $millions would reduce medicare fraud by $billions.

Pork Barrel Buster (9/10/2013 at 6:05 PM)
COuld it be that Oberthur, the largest maker of said smart cards, has their US headquarters in Rep. Gerlach's district?




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