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

Scott Mace, for HealthLeaders Media, September 10, 2013

2. Let's look around the world to see if anyone else has solved this problem, and see what we can learn from them. Taiwan has the lowest administrative cost of healthcare in the world – two percent, according to Kelli Emerick, executive director of the SecureID Coalition. One reason: They use smart cards. And I am told that Canada may have some clever ways to roll out a national patient identifier.

3. Let's put some effort into the public/private partnership that is NSTIC, the National Strategy for Trusted Identities in Cyberspace. It is the umbrella group established by executive order in 2011. NSTIC describes an "identity ecosystem" that allows individuals and organizations to trust each other through a set of agreed-upon standards and practices.

NSTIC has convened a healthcare committee which has regular conference calls, and could benefit from greater participation by providers. Already, a number of major stakeholders are participating. It is also conducting its own pilot, with the help of five awardees.

4. Engage with a group that's just been announced, the Medicare Identity Fraud Alliance. Supporters include AARP, Blue Cross and Blue Shield Association, Consumer Federation of America, ID Experts, Identity Theft Resource Center, and National Health Care Anti-Fraud Association. Get some providers involved in that effort, for a less piecemeal approach.

5. Pay attention to Patient Privacy Rights (PPR), a nonprofit which spearheads efforts in this area and hosts an annual conference, where the story recently broke of hospitals providing re-identifiable information via public health reporting requirements.

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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?