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Grassley Asking About Fraud and Waste from HHS-Where’s the Incentive for Contractors to Fight Fraud They Lose Transaction

Posted Oct 12 2010 10:55am

When it comes to fighting fraud, we are back to the fact that some Medicare contractors are owned by health insurance subsidiaries, who make transaction money from medical claims, the goods one and the ones that are fraudulent, so where’s the incentive here?  I don’t feel there’s an overcoming concern for this if they do catch fraud as they look at the balance sheets with what is generating image income.  This being said, why would a Medicare contractor want to find fraud as it stands to reduce their profits from transaction?  I guess some don’t see the full circle of how this works, and what I call “subsidiary action”.  What a company may not be able to do in one area, shove it off to be done by a subsidiary in a related area of business – it’s happening all around us with mergers and acquisitions.

HHS is kind of stuck here and their big ally is going to be agencies like the Department of Justice and it takes time for cases to work.  REMEMBER IT’S ALL THE INUSRANCE COMPANIES WITH THE BIG IT INFRASTRUCTUE AND DATA AS THEY BUILT IT UNDER LAWS AND RULES GRANTED UNDER A PRIIOR ADMINISTRATION.  The image below shows a WellPoint email address to connect with this contractor regarding government issues.  A picture is worth a 1000 words.

When it comes to awarding contracts, well what choices do they have in some areas as they are somewhat confined to who has the data and the IT systems.  Not comprehending this and asking for more of the same is not getting us anywhere.  How does Grassley want HHS to get Medicare contractors inline here, it’s almost impossible to get any great amount of cooperation?  He’s not alone with this confusion as it comes down to knowing how all the algorithmic processes work today and this is a waste of time confronting the battle in this manner and makes only for news articles to show someone is looking, and at what and how we don’t really know.

Newt Gingrich Gets Healthcare Value Bass Ackwards–It’s All About Those Algorithms

This link below from back in August along with reader comments gives some additional details on a contractor awarded a contract to monitor MD physician incentive payments, and the fact that the company is a subsidiary of Wellpoint, so put the pieces together here and perhaps with an understanding of how business processes work in the modern world today Mr. Grassley might be able to pick some better battles.  Again, HHS is kind of stuck here looking to get the job done and keep cost down so who do they award contracts too, someone who has no data and IS systems or a company owned by WellPoint that already has both the data and IT infrastructure.  I don’t like it and am just trying to educate folks here on why and how some of these decisions get made.  You need to understand business marketing and strategies today too, as they have changed a lot recently, evidenced by the big profits on Wall Street.

HHS is working with the cards from the deck that they were dealt and it’s not a good hand for the most part.  Some of the same folks don’t understand cloud service and by not approving this effort, they further tie one more government hand behind their back and force agencies to work yet in one more crippled environment and then wonder why things are not getting done.   Through ignorance and illiteracy in IT structures these folks are becoming big liabilities that affect all of us and yet they can’t see this in themselves and those who are non participants with today’s business world can see it either. 

Non tech luddites are costing us money, jobs and are allowing for more algorithmic formulas to enter Wall Street and generate more profits so if you read the news today, your heard this that profits and payments are up to again record amounts.  Perhaps if Mr. Grassley looked at the entire picture of Medicare contractors and who owns them along with their lobbying interests we could get something going rather than this same old repeated inquisition that goes nowhere.  image

As one more side note, staff members of the Senate are being treated to massages and all kinds of other healthcare food tastings, etc. this week on the taxpayer’s bill too, while the folks in North Carolina are preparing for a “free clinic” to help those without insurance.    We need leaders who understand how business is run today with technology and how algorithmic formulas have changed this entire map.  BD 

Senate Staffers Get Free Participation in a Health Fair To Include Massages, Food Tastings, Use of MP3 on the Taxpayer’s Tab
The Iowa Republican, long concerned with healthcare-related issues including transparency, waste and fraud, sent a strongly-worded letter last week to Dr. Donald Berwick, head of the Centers for Medicare and Medicaid, and his boss Kathleen Sebelius, secretary of the U.S. Dept. of Health & Human Services. Grassley wants answers on how CMS polices the contractors it uses to process Medicare claims and those charged with finding and eliminating fraud and waste.
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