PDA

View Full Version : Feds move to gain direct access to health data...




Agorism
12-22-2010, 05:07 PM
http://online.wsj.com/article/SB10001424052748704851204576034332420051722.html



In 2007, criminal investigators and prosecutors vowed to revolutionize the way they fought health-care fraud: They would mine claims data to decide what cities, types of fraud and individual providers to target.

While the data-driven strategy of the multi-agency Medicare Fraud Strike Forces—now renamed HEAT, for Health Care Fraud Prevention and Enforcement Action Teams—led to high-profile successes, the data mining never matched the hype, members of those strike forces say privately. The data they had access to was usually one to two months old, they said, not real-time as press releases sometimes claimed.

Even now, only a handful of federal fraud investigators have immediate access to real-time claims data. "We are indeed in our infancy stages here—we have a ways to go until we are wholly data-driven," said Gerald Roy, a Department of Health and Human Services deputy inspector general for investigations who leads more than 400 agents specializing in Medicare fraud.

Those agents have powers similar to their counterparts at the better-known Federal Bureau of Investigation. When Medicare or its contractors suspect fraud, they first alert the Office of the Inspector General, or OIG, which investigates the case on its own, refers it to other law-enforcement agencies, or works on joint investigations.

The OIG would only discuss cases that have been adjudicated. One such case illuminates the power of the data as well as how it was often still being used to support investigations rather than trigger them.

A single six-mile stretch of road in southern California was home to a surprising number of companies selling durable medical equipment such as wheelchairs. That's what Rene Olivas, an OIG special agent, remembers thinking when a new strike force was launched in Los Angeles in 2008. One of their priorities was durable medical equipment, so he and his colleagues started examining the companies on that stretch of road.

Sifting through the billing records, red flags popped up on one of those companies, TA Medical Supply. A lot of the patients lived out of state, as did a lot of the referring doctors—two common possible indicators of fraud. A suspiciously large number of patients received orthotics for several parts of their bodies. But truly eye-popping was this fact: More than 96% of TA's patients who received braces for the knee, ankle, elbow or wrist got them on both their left and right sides.

The owner of TA Medical Supply, Melkon Gabriyelyan, pleaded guilty in 2008 to health-care fraud and identity theft and was sentenced to 54 months in prison. One of his lawyers, Vicken Hagopian, described him as "straight-shooting, hard-working." He said his client had been advised by his previous attorney to accept a plea deal, and added, "We believe Gabriyelyan was truly operating a legitimate business."

Mr. Hagopian said TA Medical Supply is no longer in business, and he described it as a one-person operation.

Mr. Roy would like to see Medicare and his investigators catch such aberrant billing patterns earlier so that Medicare could stop paying quickly to minimize taxpayer losses. He said he is working to gain access to claims data that is no more than 24 hours old and to set up a center, with offshoots in key cities, where his agents and other law-enforcement officials could analyze the data.

Meanwhile, almost 285 OIG agents—up from about 50 three years ago—have been trained and have direct access to the system that lets them see the claims data that is one to two months old, according to OIG. But the difference isn't just the numbers, Mr. Roy said. Back then, "the emphasis wasn't on the data," said Mr. Roy. "We really impressed on our agents this is a tool you need to use more."

Stary Hickory
12-22-2010, 05:52 PM
And they never stop.....this is why revolution is inevitable. No matter how much they take it's never enough.

Secession, at the personal and state level, is the answer. No more of this....FCC just got finished blatantly abusing the law, disobeying a direct court order and circumventing the congress...and yet they are onto their next conquest of our freedoms.

Agorism
12-22-2010, 05:55 PM
This is like when Nixon stole Ellsberg's medical records because he was a threat to release the Pentagon papers.


http://www.youtube.com/watch?v=ejvyDn1TPr8