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Senators Letter to HHS Regarding Fraud Reform Tools–Oddest Thing I Have Read in a Long Time and Really Makes A Huge Case f

Posted Apr 09 2013 10:21pm

You know what HHS finally just has their anti fraud software working.  Let it work but some and impatient here and when I see Tom Coburn named here on this request I can’t but help but think he’s still a “paper” doctor.  He should know better and be well advised being this is in the area where he worked for so long!  You know you never hear a peep out of him either when it comes to electronic medical records…think I’m on to something (grin).  Seriously the Sunshine Foundation and their recommendation should really be taken to heart.  Come on it’s not enough that Digital Illit Gingrich is testing Google Glass (which I guess is a good thing as if he can use them anyone can)  and now this….

Congress Needs a Bigger Brain–Restore the Office of Technology Assessment And Truly Assess What is Useful And Remove The Algo Duping Permeating In Government–Fantasy Perceptions That Are Not Real Can Be A Dangerous Thing

To really appreciate the full spectrum of all of this you have to go back to what HHS was doing a while back too with the letter that Sebelius and Holder put out accusing hospitals and doctors of cheating on billing with bringing absolutely nothing to the table and telling Health IT people to hurry up.   It was just like DOJ Manny with a voice showing no confidence at all battling banks that work technology up his back side constantly and the perception of bliss he showed.  What is it with these folks…even at Harvard they wrote about that letter.  Vendors shook their heads..it’s like what is this?  Used to be I was picking on the GOP mostly as they seem to open mouth and insert foot pretty regularly but now we have the other side doing the same thing so I guess digital illiteracy is truly a non partisan issue:)  What’s with these folks with hurrying up IT …what’s next water boarding developers to get the code out of them faster?  This letter just ranks right up there with this one…

Digital Literacy Needed–Senator McConnell Staff Falls for Parody Blog Post–Everything On the Internet Is Not True, Duped, Duped and Duped Again

Can’t the folks over at the Senate be a little patient here?  The software is in place and is now working…see below on the big numbers on the second link below…wish people could do math a little better and understand mechanics of computer code and models. 

CMS Announces Anti-Fraud Algorithms Will Begin Auditing Claims on July 1, 2011 Just As Insurance Companies Have Done For Years

But wait, only a month or two after the “cheating letter” went out we had this so Sebelius and Holder could once again breath easier:) The software is the key to finding patterns and identifying theft and those old folks at the Senate are just out of patience I guess in giving it time to work.  Boy I bet this felt good to see this headline come out after accusing all of cheating with nothing brought to the table or even a simple example.  Best not to ride ponies that have a stick instead of 4 legs, those are real and can take you somewhere (grin). 

Medicaid Fraud–With Numbers This Good Using Anti Fraud Analytics To Help Identify Patterns, Maybe Some Cheating Obsessions Might Lighten Up A Little

You know we also have this most wanted list going on too, a good thing.

HHS Creates 'Most Wanted' List Website for Healthcare Fraud - Office of the Inspector General


Here’s the meat and potatoes of the letter below, but gee let the software do it’s work and help enforcement as they will find and target patterns and where fraud is occurring.  Again, if these folks in the Senate had a better understanding of how this process works and the fact that it needs a little more time as it just got going in the last few months…I think this is a good step as the software certainly works for insurers even to the point of maybe working too well with some false positives in there but that’s another story which comes under the topic of knowing how to use analytics wisely and smart…yes folks get that Office of Technology Assistance back and going and let other executives participate in the knowledge they would have to offer as well.  Just spare us any more women’s health issues for a while too, that would be appreciated.  I did a post about folks who let software take them over the edge with being duped but these folks can’t seem to even recognize a cliff when they see one.  BD


For the past two years, we have written to you requesting information about the discretionary authority granted to you as Secretary of the Department of Health and Human Services (HHS) through Section 6401(a)(6) of the Patient Protection and Affordable Care Act (PPACA) regarding the imposition of a temporary moratorium on the enrollment of new providers and suppliers.  The answers that we received from both you and Acting Administrator Tavenner have not provided us with satisfactory answers about when the Centers for Medicare & Medicaid Services (CMS) might begin using this authority.

“CMS has yet to utilize this tool provided in PPACA to prevent waste, fraud and abuse.

“It has now been three years since PPACA was enacted and over two years since CMS published a final rule that allowed CMS to impose a temporary enrollment moratorium on new Medicare providers and suppliers when CMS determines that there is a significant potential for fraud, waste, or abuse with respect to a particular provider or supplier type, geographic area or both.    To date, not a single action has been taken by CMS using this authority.

“It is not reasonable to suggest that CMS needs more time to study whether there is a need to impose a temporary moratorium in certain geographical areas for certain provider and supplier types when ample evidence exists to justify moratoria in these high fraud areas.  To better understand CMS’s failure to act, please:

* Explain why CMS has not imposed a temporary moratorium of “high” or “moderate” categorical risk providers/suppliers in HHS-OIG strike force cities or other high-risk areas.

“HHS and CMS have a duty to ensure that taxpayer dollars are being carefully stewarded and that all available tools are being utilized to combat health care fraud nationwide.  Therefore, we appreciate your assistance in helping us better understand what HHS and CMS are doing to address these issues.  Thank you for your timely attention to this request and we look forward to receiving your response by April 19, 2013.” 


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