IT used against Medicaid abuse

GAO Report: "Medicaid Program Integrity: State and Federal Efforts to Prevent and Detect Improper Payments"

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Technology has become a basic tool in states' efforts to combat Medicaid fraud and abuse, according to a Government Accounability Office report released this week.

In a review of the Medicaid program's integrity, GAO auditors found that the majority of states are using technology not only to maintain records, but also to prevent improper payments through measures such preauthorization.

For example, 32 states are using Web-based systems that require pharmacies to confirm the eligibility of someone seeking to fill a prescription before providing any drugs, according to GAO's Aug. 19 report. Twenty-one states are also using data warehouses and data-mining applications to find patterns in billing that might indicate abuse.

Such technologies have already saved states millions of dollars, according to the report. Data mining saved $24.9 million in fiscal 2002 and 2003 in New York; $14 million from fiscal 2000 to 2002 in Ohio; and $18.9 million in fiscal 2003 in Texas.

Many states also use contractors to supplement their in-house technology resources when it comes to reviewing claims. In addition to saving money by avoiding improper payments, using contractors to enhance a state's capabilities has resulted in significant improvements in processing time, the report states.

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