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WellPoint Gets Message from Medicare to suspend 2 Part D programs

Posted Jan 15 2009 6:25pm

Wait one second, the computer system caused the problem, I am just curious as it takes algorithms to run and query, so who did the programming to cause the errors?  It seems there’s been a lot of this going on of late, with the computer glitches creating errors. 

Do we not run these queries on sample data on a virtual server to first view the outcomes to ensure we have the desired results?  Also, as mentioned, the audit trails will tell all, if anyone looks at the reports too.  One reason why the reporting functions of systems is so important today, along with analysts to timely audit and review before the algorithms get out in the masses.   Industries such as Wall Street and Health Insurance firms who were the absolute fore runners in establishing the best IT technology sure seem to be coming to the forefront with money issues, like Madoff, perhaps something in common with “bad formulas” or algorithms?  

The formulas kick out what they are programmed to do, so I do wonder what type of “business intelligence” is operating out there?  Ingenix had problems too with a “flawed” data base?  How did it become flawed I might wonder, was it the algorithms programmed in to kick out results that did this?  These things do not happen by accident.  BD

WellPoint has been forced to suspend its solicitation and marketing of two Medi image care programs by the U.S. Centers for Medicare and Medicaid Services.

The federal agency said WellPoint (nyse: WLP - news - people ) had "demonstrated a longstanding and persistent failure" to comply with regulations and that its conduct had long been posing "a serious threat to the health and safety of Medicare beneficiaries."

According to the government, WellPoint failed to provide beneficiaries of Medicare Advantage and Medicare Part D with proper enrollment, a low-income subsidy benefit and prompt payment of claims, as well as several other violations concerning marketing and enrollee premiums. The insurer is also accused of overcharging beneficiaries for their share of drugs and not getting them the drugs they needed for conditions like diabetes, heart disease, respiratory distress, and seizures.

The problems were discovered through self-audits by WellPoint and audits by Medicare that showed the computer systems through which the insurer organizes its programs may have caused the problem.

WellPoint Gets Red Card From Medicare - Forbes.com

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