CMS gives states better look at health care data

The Centers for Medicaid and Medicare is helping state and local agencies use analytic software to improve the quality of health care data and to prevent fraud and abuse. The results'on a small scale so far'have been positive.

New York has 17 of its 57 counties tracking drug usage patterns for signs of abuse and program effectiveness, and audit controls. And one county, Chemung, expects to save between $2 million and $5 million annually from having better data to base decisions on. Overall, New York officials said, savings statewide could be in the billions.

Congress charged CMS with reforming Medicare and with reducing fraud and abuse in Medicaid. Although states, which administer Medicaid, police for fraud, CMS provides technical assistance and oversight.

CMS is tying funds to its anti-fraud initiative. A state's failure to meet fraud and abuse recovery targets will result in penalties and prevent the state from receiving health care funds from CMS, said Stephen Acquario, executive director of the New York State Association of Counties.

Fraud management

Teradata, a division of NCR Corp. of Dayton, Ohio, is using the same underlying fraud and abuse management technology for New York's Medicaid Management Information System, or eMedNY, as is used on the federal level, said Stephen Brobst, Teradata chief technology officer. Computer Sciences Corp. is the lead contractor, while Bull Services Inc. of Bellerica, Mass., provides the data warehouse to consolidate hundreds of millions of Medicaid records.

Several New York counties use business performance management software from Salient Corp. of Horseheads, N.Y., to help manage Medicaid, reduce fraud and abuse, and enhance local service efficiency.

Salient's Muni-Minder analyzes high volumes of Medicaid data, including how money is spent and recipients are managed. Users can access and compare data, and create graphics to illustrate and better understand it.

Until this year, only state offices could review provider Medicaid claims, Acquario said. Twelve counties now are examining such data in a demonstration program.
'Many of those are using data-mining tools, which hopefully will return money to the federal government,' Acquario said.

About the Author

Mary Mosquera is a reporter for Federal Computer Week.

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