Medicaid Fraud to be Sniffed Out by Austin Company - Healthcare | Financial Buzz

Medicaid Fraud to be Sniffed Out by Austin Company

Fraud, Medicaid, Texas, FBIFraud in Medicaid constitutes a scam amounting to more than a billion dollars and a newly installed computer system is assisting to ferret out the criminals. As per Kaiser, about $28 billion is paid by Texas to provide care for a population of 4.8 million.

One fourth of the total tab is picked up by the state. The rest is paid by the Federal Government. According to the Federal Bureau of Investigation (FBI), about 10 percent of the Medicaid claims are done under false pretenses. This amounts to approximately $2.8 billion per year in Texas only.

Fighting fraud

On August 4, 21CT, an Austin headquartered company, had launched a novel computer system which will bring such scammers into legal chains. The computer system has been named “Torch”.

The Torch computer system will collect data at all times, 24 x7. The system will have complete access to the claims frequency, the claims size and has the capability to distinguish any kind of anomalies or patterns that do not fit into the framework.

21CT already has 100 employees on its payrolls, a majority of them working to crack down on fraudsters. According to company officials, the findings are an eye opener.

Efficient fraud detection system

Kyle Flaherty, Vice President, Marketing, 21CT, says that it is clear that fraud was always there. The surprising thing is the sheer entrepreneurial nature of the fraudsters. Frauds are generally complex and are a veritable business for such criminals. There is therefore the need to destroy the business which the criminals have created.

Torch will closely observe all the providers: doctors, dentists, companies supplying medical equipment, hospitals and any other peer entity. Ross Worden, Director, Data Science, at 21CT, says that he had previously worked as an investigator in healthcare fraud cases and he has had multiple browser windows opened at the same time so that he could work with a semblance of sense. He added that the new system has made the task much easier. The person operating the system simply has to click to see the connection between multiple entities and their potential actions. Worden expressed that Torch is a superlative tool.

However, Torch will not let the general public know how it latches on to fraudsters. The reason is that the criminals may change their tactics to avoid detection. Criminal behavior is said to include strange transaction accounts, unsavory networks and suspicious associations.

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