Obama's health plan would expand use of IT

It would set up new sanctions database, Medicare-IRS data checks

President Barack Obama’s plan to overhaul health care, which he outlined today, would create several new federal databases and information technology systems to identify and punish violations and frauds.

For example, the plan would establish a new “Comprehensive Sanctions” Medicare and Medicaid database that would be overseen by the Health and Human Services Department’s (HHS) inspector general. The database would detail penalties levied against doctors, hospitals and suppliers and would be available to law enforcement agencies.

It also would establish real-time analysis of claims and payments data for Medicare and Medicaid to identify apparently fraudulent claims in public health programs. “The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly. It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse,” the proposal states.

The anti-fraud provisions also include plans to set up a system to match data from Medicaid and Medicare claims against Internal Revenue Service filings to identify whether a doctor collecting payments has a “seriously delinquent” tax debt.

“By requiring the IRS to disclose to the Centers for Medicare and Medicaid services those entities that have evaded filing taxes and matching the data against provider billing data, this proposal will enable CMS to better detect fraudulent providers billing the Medicare program,” the plan said.

Obama also said he would seek expanded access to the Healthcare Integrity and Protection Data Bank to include peer review and quality control organizations and private health plans. The data bank was created in 1999 to flag apparent fraudulent claims for public health expenditures.

In addition, Medicare would adopt new “credit card” technology that provides real-time information to determine in advance of payment whether a claim meets program coverage and other requirements, the president’s proposal said.

HHS would report to Congress on whether universal product numbers should be assigned to selected items and services reimbursed under Medicare. The report would examine the costs and benefits of such a plan.


About the Author

Alice Lipowicz is a staff writer covering government 2.0, homeland security and other IT policies for Federal Computer Week.

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