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HHS and DOJ Send Letters to Hospital Trade Associations Warning of Gaming Billing System Via Use of Electronic Medical Records&#

Posted Sep 26 2012 5:35pm

I know this is a double edge sword but how many consultants are there out there who promise results and bigger profits?  It’s all over imagethe place and some of these consultants hired by hospitals, guess what, are owned by insurance companies.  Is this the pot calling the kettle black?  Certainly there are the exceptions which are out and out fraud and those folks should be investigated but to take the fact that Medicare grew in reimbursements from 2006 to 2010 and say folks are gaming the system?  Copy and paste, not going away as doctors have their standard templates they use for certain conditions so try being a doctor seeing a very heavy load of patients for the day and not allowing and copy of paste..forget it…most of it is very legal and well used.

Upcoding is the other issue and that’s been around for a long time and remember there are consultants that may be a little gray in some of these areas when advising hospitals….remember Accretive..shoot those folks even were showing actual patient records to investors on Wall Street…with paying out money for consultants of course they got better at billing and coding.  When someone pays for this type of service they don’t expect to get worse.  Again if we had some folks around with “some” Health IT knowledge in key positions we wouldn’t hear stuff like this in the news with blaming the electronic records…why just plain on figurehead executives need to move on soon before they sink us all.  We did have this from HCA but hear nothing about looking at them for upcoding…red flag maybe for an audit?  Was that IPO that successful? 



Actually I wrote this up a while back on “swapping spit” if you will on some of the money they chase and how there’s probably more money and time spent chasing than what they recover.  It comes back to formulas, math and algorithms and the naïve executives we have that don’t think this way, but they should instead of going on a verbal witch hunt.  You have to remember that the payables system used today was modeled from insurance carriers for a lot of it and there has been numerous mentions on how the current medical records don’t have the original focus of being useful and helpful for the doctor, but rather are written for the payable side, so does that make sense?

Yet one more example here of being Algo Duped is the readmission penalties.  It’s a money shifter and makes it hard for hospitals to budget and the dream again of those who are not up to snuff with how data works thinking there’s a magical algorithm that will solve this issue.  I think of this naïve issue every time I look at the Heritage $ 3 million dollar carrot out there to find the answer, supported by former HHS director Leavitt, he got Algo Duped but again those who don’t understand data, what it can do, the amount of time and effort and intelligence needed, we get this where they think an algorithm is a cure all…sad.  Just my opinion only I thought HHS lost it with their Facebook contest…give me a break as we certainly don’t have a shortage of consumer Health IT apps and even Best Buy today hawks software from Aetna in their stores. 

This is getting real old to think that there’s an algorithm solution for everything, and granted some make us smarter, some create desired results and make people rich and some are just a fable and here’s some Quants in this video documentary that will enlighten you.     

The citizens of the US deserve something better than an old blame shifting witch hunt statement from those in executive positions without enough documentation as we find ourselves under the Attack of the Killer Algorithms by day and night, something that needs to be acknowledged and corrected as we have way too many that don’t deploy enough accuracy but sure deliver the desired results (billions of dollars) to many and part of the business models are not much more than fiction.  The link below has a vide that fill you in. BD


The Obama administration has issued a strong and much-needed warning to hospitals and doctors about the fraudulent use of electronic medical records to illegally inflate their billings to Medicare. Attorney General Eric Holder Jr. and the health and human services secretary, Kathleen Sebelius, cited “troubling indications” that some providers are billing for services never provided and vowed to prosecute. They sent a letter to five major hospital trade associations on Monday, two days after an article in The Times described in detail how greater use of electronic records might be making it easier for hospitals and doctors to submit erroneous payment claims.

http://www.nytimes.com/2012/09/26/opinion/abuse-of-electronic-medical-records.html


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