Medicare Data Base–It Is Not Ready for Prime Time To Expose to the Web Due to Errors Factors and Consumer Credibility In I
Posted Oct 26 2010 10:45am
We are all working to make as much data as possible public but sometimes until we are ready for prime time it may not be in our best interests to display data that is riddled with errors until audits are done and a certain amount of credibility can be shown. I have been reading along a bit with this debate and with all the other information that is out there today on the web it might be a tad bit early to put such information out there. There’s certainly a lot of talk about Medicare Contractors being put to the test of finding more fraud and any efforts in finding an identifying fraud are to be commended of course as we all lose with criminal activity.
As an example here in this effort, even companies that operate for profit and sell information on doctors and hospitals are experiencing the same issues, not updated and as I commented, dead doctors, wrong specialties listed, old addresses from years before and so on. The information is gathered from insurance companies and state boards so if this effort in the profit area is failing to have a greater accuracy level how would an error riddled Medicare data base look on the web, think about it.
Furthermore other sites either license or use the same data bases so this adds even more clutter and misdirection. As consumers we all want credible information but must also realize that this information is being compiled with years of manual human data input from many sources and thus error levels are there.
When thinking about this topic, also give some thought to the fact that some Medicare contractors are wholly owned subsidiaries of health insurance companies and they operate for a profit and create profits from transaction fees which all go to the overall bottom line of profit, so it makes one wonder how much effort is given to fight fraud when the overall focus of money to the bottom is is there, in other words will finding too much fraud cut into other areas of automated algorithmic revenue that comes from processing medical claims? In the link below I had a reader that added more to what I wrote and explains quite a bit in layman’s terms. If we are not looking at the changing face of how company subsidiaries everywhere are operating with business intelligence created data, then shame on us as it’s happening all around and your former perceptions may be off base, it’s a rapidly changing world based on profits and money.
This is the outcome today of systems and outsourcing of data that was set up under prior administrations and what is left for us to work with today. Again, if you are not paying attention to subsidiary actions of companies and thinking about how they are combining, querying and issuing new business models of operation, then you are in the dark and at a disadvantage. Last year Medicare found big loophole with not using the social security death index and had egg on their face over this, so I ask is this a government or contractor issue? I think it’s a good question and certainly is an area to pursue for fraud by all means.
In another related story, how does a city pay out this kind of money on employees that have been dead for several years? How does this occur? Was there no effort too her with insurers at least asking for some mammograms and other preventive tests to catch some of this? Where was the effort of the insurers here besides taking in 2 million and if you want to look at it another way was it a cash cow as there of course would be no medical claims coming in for these folks, just a question that popped into my head. I’m in doctors office all the time that get requests from insurance companies asking why Jane Doe has not had her annual mammogram and these are requests that are looking to grade the doctor on pay for performance and the practice has to write back and tell them that Jane Doe has been dead for 3 years.
Do you see the point here, we seem to be missing stuff and the Medicare data base will be full of the same types of items. While on this topic, this is a very good reason to use the Blue Button and get your own records by all means and check for accuracy.
If you have not visited the Medicare.Gov site recently, it’s worth a look and again like Healthcare.Gov it looks nothing like a traditional government website, which is a good thing in this case as it is very easy to navigate. If you are looking for information about Medicare Advantage plans you can go here.
“MyMedicare.gov has a new feature called “Blue Button”. This new feature provides you an easy way to download your personal health information to a file. You can download the file of your personal data and save the file on your own personal computer. After you have saved it, you can import that same file into other computer-based personal health management tools. The Blue Button is safe, secure, reliable and easy to use!
One other area of interest to check and see what data is held on you is the MIB which has been around for years. There are errors there too and people get denied coverage of what is found in some of those files where insurers have been comparing notes on the insured for years. Like everyone else out there today they have evolved into a software warehouse too with goods to sell.
This new affiliation is all about data and the ability to evaluate mortality risk, in other words what is your anticipated time to check out. This does make one a bit uneasy when you see derivatives like this on the market where pools of diseased groups carry on a life insurance policy and bet on the life expectancy, pretty sick in my estimation, but companies provide them the data to do so and they make a lot of money at it.
So there’s yet one more area to check when it comes to data that has been accumulated and used for risk management scores.
From the website:
“MIB Solutions, a wholly-owned subsidiary of the MIB Group, Inc., develops and markets products and services that help insurance companies make better, more informed underwriting and risk management decisions. In addition to new products and services, our mission is to expand MIB's core fraud detection and deterrence services into new markets.”
“These core competencies, combined with our unique industry positioning, make MIB Solutions, Inc. a leading provider of risk management products and services that give insurance executives the capabilities they require to improve business performance, increase effectiveness and, ultimately, enhance profitability.”
You can be the judge here now perhaps after seeing everything else that is out there and do we need more clutter until we can safely put information out there is is correct? I agree with the AMA on this stance and there is certainly a lot of room for corrections and improvements, but until we have data integrity here and provide verified information on the physicians, we are kind of shooting ourselves in the foot.
As a Medicare recipient, go get your data.
Anyway those are my thoughts here and hopefully I have added some information of interest as to who has the data, who’s working with and how the government is not always the keeper of all of this data, and they are making big strides to get more in house with IT infrastructure updates after a number of years of administrations that didn’t see all of this coming. The data folks for profit just keep working away while many of us became distracted with all that is in the news today too.
As a final thought on insurance companies buying subsidiaries read this link and you can probably figure out the purchase of this company in China as talks to keep cost down continue. Again, pay attention in this area as it gets gray and clouded very quickly and the data aggregation and analysis processes work 24/7.
My intentions here are in the effort to try and elevate our awareness of what is happening around us by the minute as it is changing at that pace today as well and right now with the error factors in the Medicare data base I believe it would stand to create more confusion and distraught and doctors would not be viewed accurately and stand to further cloud the water. When a high level of accuracy can be provided in the future, then perhaps a second look would be in order. This is the hand that the current administration has been dealt and is trying to work with. BD
The Journal focused on one family-practice doctor with extremely high billing and found she had performed an unusual array of 29 tests, some of which have been flagged by federal authorities as being frequently abused. Only 25 other providers performed more than 20 of those same tests. Several of those providers have been accused of misconduct. The numbers here are derived from a database comprising a 5% sample of Medicare beneficiaries. Below, see details on the providers' testing and how they compare to the average. Click once to sort; click a second time to show the data in bars.