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

Scott Mace, for HealthLeaders Media, September 10, 2013

3. Government is really good at building silos of information, one act of Congress at a time. Government is really bad at integrating these silos of information quickly or inexpensively. At a HIMSS analytics conference this June, one speaker said that CMS alone has multiple data warehouses, built over the years, which have great difficulty sharing information with each other.

4. HIPAA currently has a prohibition against the federal government planning or even researching a national patient identifier system. H.R. 3024 claims the Medicare smart card pilot will be compliant with HIPAA. That should be interesting to watch, particularly after the HHS lawyers get through with it.

5. Should we have a smart card for every possible use in society? That's the direction modern society is going. Library cards, brand loyalty cards, insurance cards, keys as cards – they're all getting smarter. But no one is making wallets any bigger. Or if they are, they shouldn't be. We will need flexibility, so at the consumer's discretion, they can use one smart card in multiple ways.

With all these problems, it's no wonder that "analysis paralysis" seems to be the order of the day. Now let me suggest what can be done about it.

5 Proposals

1. We should let Rep. Gerlach and his Medicare smart card allies make their case. Similar legislation was introduced in the last Congress but didn't get anywhere. This time, let's hold a hearing. Capitol Hill holds lots of hearings about what's wrong with healthcare in this country. It's time for (another) hearing or two about the role that technology can play to solve the identity problem, the fraud problem, and the problem of Congress building one information silo after another.

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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?