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

Scott Mace, for HealthLeaders Media, September 10, 2013

Meanwhile, today's Medicare card is a piece of paper with no intelligence. Dare I say it, it's downright stupid. That's because the Medicare member's Social Security number is printed right on the card.

Yes, that means everyone who comes in contact with that card, from clerks on their first day on the job to EMTs making a midnight run, has access to that Social Security number.

If CMS could be sued for HIPAA violations, it would be.

But since it can't, I am left wondering why Medicare is so far behind the rest of society, and facing its own share of responsibility for the fraud and inefficiency so often ascribed to it. The truth is that behind tales of the same old government inefficiency and inertia is a tremendous debate about the role that digital identity plays in our modern world.

Summed up, the very technology that could solve our identity and fraud problems could open up tremendous privacy concerns, due to the very powerful effect that digitizing all our personal details has on the ability to aggregate and, unfortunately, abuse that information.

5 Data Problems

1. Consumers have no easy way to read the information stored on the smart cards they carry. So they can't verify the accuracy of that information without a lot more help.

2. Smart cards may help verify a patient's identity at the clinic, but they provide no benefit for the consumer at home trying to log into a patient portal or other online health services, again because there are no home readers or standards for same.

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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?